Supracricoid laryngectomy for primary or recurrent laryngeal cancer
From Ask Dr Wiki
Supracricoid laryngectomy is a partial laryngectomy. A partial laryngectomy is a procedure mostly performed for cancer of the larynx. During a partial laryngectomy, part of the larynx is removed, but a functioning part is preserved. There are various, technically very different, kinds of partial laryngectomies. Besides supracricoid laryngectomy, they include hemilaryngectomy, frontolateral laryngectomy, supraglottic laryngectomy, endoscopic laser resections and others.
The aim of a supracricoid laryngectomy is to fully remove the cancer, while creating a new functional larynx. The entire thyroid cartilage, including both vocal cords and sometimes even one arytenoid are removed. The reconstruction takes place by mobilizing the remaining laryngeal structures and suturing the cricoid to the hyoid bone. A temporary tracheotomy is performed.
There are two varieties of supracricoid laryngectomy: the Crico-Hyoido- Epiglotto-Pexy (CHEP) and the Crico-Hyoido-Pexy (CHP). The difference between the two is that in CHP, contrary to CHEP, the entire epiglottis and pre-epiglottic space are removed. CHEP and CHP are frequently used as synonyms for supracricoid laryngectomy.
After the rehabilitation period, patients are able to swallow in the regular way. Sometimes, slight aspiration may exist. Vibration of mucosa of the arytenoids produces voice.
Supracricoid laryngectomy may be used as primary treatment or as salvage treatment after failure of radiotherapy.
Primary indications mainly include glottic T2 carcinomas, although the procedure may be used for T1 tumors and selected T3 tumors as well. From the literature, it appears that local control for T2 tumors may be slightly higher than with radiotherapy. The voice after surgery is generally worse than after radiotherapy.
Selected patients who have failed radiotherapy for T1 and T2 tumors may also be candidates for supracricoid laryngectomy as an alternative to total laryngectomy. In this category of patients good local control rates and function have been reported.