A New 'Y' Shape Partial Laryngectomy for Supraglottic Carcinoma with Anterior Commissure Invasion or Encroachment

Choi, Eun Chang; Koh, Yoon Woo; Jo, Sung Woo; Choi, Yoon Suk; Kim, Jin Young

Abstract

BACKGROUND AND OBJECTIVES: Supraglottic partial laryngectomy (SPL) is contraindicated when lower margin of the tumor invades the anterior commissure or encroaches on it. Those cases are usually treated with supracricoid laryngectomy or near- total or total laryngectomy. But all these procedures have to sacrifice innocent true vocal cords, not because of oncological concerns but because of reconstruction concerns. We designed a new Y-shape partial laryngectomy with preserving vocal cords for this particular situation.
PATIENTS AND METHODS
Thyrotomy consists of two incisions, upper and lower. The upper incision was made oblique from superior cornu down to the anterior commissure. When this incision was made 5 mm lateral to the midline, it went down to the inferior border of thyroid cartilage. This modification enables resection enbloc anterior commissure region with SPI. specimen. At closure, both ends of the true cord is anchored to the thyrotomy margin. Each lamina is connected with one miniplate with 6 holes. Then the closure is reinforced with elevated thyroid perichondrium and strap muscles.
RESULTS
Two patients were treated with this type of surgery. Both had negative surgical margins. In the postoperative period, no specific complications were noted. Roth of them could decannulate and swallow without aspiration on the 20th day following the surgery. They retained their voices from the true vocal cords.
CONCLUSION
This new partial laryngectomy technique could apply to supraglottic carcinoma cases with anterior commissure invasion or encroachment without sacrificing true cords. This procedure provides satisfactory swallowing and postoperative phonatoty function even with resection of the supraglottic structure.