Near-Total Laryngectomy Workup

  • Author: Brian Kip Reilly, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Feb 23, 2012
 

Laboratory Studies

Order routine laboratory studies, including a basic chemistry panel (BMP), liver function test (LFT), and a complete blood count (CBC) to get a health baseline and look for metastases.

Elevated alkaline phosphatase indicates possible metastases or concomitant liver disease.

Elevated calcium levels should prompt further work-up for metastases.

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Imaging Studies

Obtain a CT scan of the chest to rule out pulmonary metastases or synchronous primary tumors.

Order a neck/laryngeal CT scan with contrast for evaluation of cervical metastases to determine the presence or absence of cartilage invasion.

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Other Tests

Patients often have chronic obstructive pulmonary disease (COPD) because of their heavy history of smoking. Pulmonary function tests may be indicated for some patients to determine pulmonary reserve and can help predict if lungs have sufficient power for phonation via the vibratory myomucosal shut.

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Diagnostic Procedures

Endoscopy should be performed prior to any type of laryngectomy to rule out synchronous primary cancers and to evaluate the primary laryngeal lesion and its appropriateness for surgery.

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Histologic Findings

  • Greater than 93% of laryngeal tumors have a squamous cell histopathology.
  • Verrucous carcinomas are present in 2-4% of cases.
  • Adenocarcinomas and sarcomas occur in approximately 1% of cases, respectively.
  • The use of intraoperative frozen sections determines how extensive the resection must be to ensure complete excision of the lesion.
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Staging

Laryngeal cancers are staged both clinically and radiographically prior to surgery. CT scans of the larynx with fine cuts, CT scans of the neck with and without contrast, and CT scans of the chest are obtained to characterize local spread and metastatic disease. Staging is generally performed as part of the endoscopy of stage T3 and T4 lesions.

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Contributor Information and Disclosures
Author

Brian Kip Reilly, MD  Assistant Professor of Otolaryngology and Pediatrics, Department of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine

Brian Kip Reilly, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Barry L Wenig, MD, MPH, FACS  Professor, Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University; Chief, Division of Otolaryngology-Head and Neck Surgery, Evanston Northwestern Healthcare

Barry L Wenig, MD, MPH, FACS is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Rhinologic Society, American Society for Head and Neck Surgery, American Society for Laser Medicine and Surgery, Association for Research in Otolaryngology, Chicago Medical Society, New York Academy of Medicine, New York Academy of Sciences, New York Head and Neck Society, Society for Ear, Nose and Throat Advances in Children, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

M Abraham Kuriakose, MD, DDS, FRCS  Chairman, Head and Neck Institute, Amrita Institute of Medical Sciences

M Abraham Kuriakose, MD, DDS, FRCS is a member of the following medical societies: American Association for Cancer Research, American Head and Neck Society, British Association of Oral and Maxillofacial Surgeons, and Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Nader Sadeghi, MD, FRCSC  Professor, Otolaryngology-Head and Neck Surgery, Director of Head and Neck Surgery, George Washington University School of Medicine and Health Sciences

Nader Sadeghi, MD, FRCSC is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Thyroid Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

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Lateral radiograph of the neck showing the different structures of the larynx: a, vallecula; b, hyoid bone; c, epiglottis; d, pre-epiglottic space; e, ventricle (air-space between false and true cords); f, arytenoid; g, cricoid; and h, thyroid cartilage.
 
 
 
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