Supracricoid Laryngectomy Workup

  • Author: Stephen Y Lai, MD, PhD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Feb 23, 2012
 

Imaging Studies

  • Computerized tomography (CT) scanning and magnetic resonance imaging (MRI) provide confirmatory information regarding the status of the paraglottic and preepiglottic spaces. Also, these techniques provide information regarding metastatic involvement of the regional lymphatics of the neck, subglottic tumor extension, and potential invasion of the thyroid and cricoid cartilage.
  • Endoscopic evaluation remains a superior method for evaluating superficial lesions and the mucosal extent of the cancer.
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Diagnostic Procedures

  • Direct laryngoscopy
    • Direct laryngoscopy under general anesthesia allows for thorough evaluation of the larynx and precise tumor mapping. Palpation of the lesion and surrounding structures allows for estimation of the depth of infiltration. The arytenoid cartilages are palpated to assess the status of the cricoarytenoid joint.
    • Points for assessment include the following:
      • Degree of alteration of mobility of the true vocal cord
      • Degree of alteration of mobility of the arytenoid cartilage
      • Involvement of the anterior commissure
      • Degree of invasion of the subglottis
      • Status of the mucosa surrounding the primary site
      • Degree of invasion of the preepiglottic space
      • Invasion of the thyroid cartilage
    • Mobility of the true vocal cords, arytenoid cartilages, and false vocal cords indicates the depth of cancer invasion. True fixation of the arytenoid cartilage is always associated with fixation of the true vocal cord, indicating infiltration of the cricoarytenoid joint and/or musculature. This posterolateral cricoid involvement is a major contraindication to any organ preservation surgery techniques. While true vocal cord immobility is a contraindication to SGL and VPL, fixation of the true vocal cord with some mobility of the arytenoid is not a contraindication to SCPL.
    • Impairment or fixation of the true vocal cord in glottic carcinoma indicates invasion of the thyroarytenoid muscle. The depth of invasion is directly related to the degree to which cord motion is impaired.
    • At the supraglottic level, the most common cause of cord fixation is deep arytenoid cartilage invasion. However, an important distinction exists between true vocal cord fixation and arytenoid cartilage fixation. Hypopharyngeal or epilaryngeal supraglottic carcinomas might appear to affect mobility of the arytenoid cartilages because of gross tumor characteristics but leave true vocal cord mobility unaffected or impaired rather than fixed. This pseudofixation is unlikely to represent malignant invasion of the cricoarytenoid joint and/or musculature, suggesting that laryngeal preservation techniques may be employed.
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Contributor Information and Disclosures
Author

Stephen Y Lai, MD, PhD  Associate Professor, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center

Stephen Y Lai, MD, PhD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for Cancer Research, American Head and Neck Society, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: GlaxoSmithKline Grant/research funds None; Neoprobe Grant/research funds clinical trial

Coauthor(s)

Gregory S Weinstein, MD, FACS  Professor and Vice-Chairman, Department of Otorhinolaryngology-Head and Neck Surgery, Director of Division of Head and Neck Surgery, Director of Head and Oncology Fellowship, Director of Otorhinolaryngology-Head and Neck Clinic, Co-director of The Center for Head and Neck Surgery, University of Pennsylvania School of Medicine

Gregory S Weinstein, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Radium Society, American Society for Head and Neck Surgery, Pennsylvania Medical Society, Philadelphia County Medical Society, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Kelley, MD  Consulting Staff, Eastern Shore ENT and Allergy Associates and Peninsula Regional Medical Center

Daniel J Kelley, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Laryngological Rhinological and Otological Society, and Pennsylvania Medical Society

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

References

  1. Benito J, Holsinger FC, Pérez-Martín A, Garcia D, Weinstein GS, Laccourreye O. Aspiration after supracricoid partial laryngectomy: Incidence, risk factors, management, and outcomes. Head Neck. May 2011;33(5):679-85. [Medline].

  2. Joo YH, Sun DI, Cho JH, Cho KJ, Kim MS. Factors that predict postoperative pulmonary complications after supracricoid partial laryngectomy. Arch Otolaryngol Head Neck Surg. Nov 2009;135(11):1154-7. [Medline].

  3. Hirano M, Kurita S, Kiyokawa K, Sato K. Posterior glottis. Morphological study in excised human larynges. Ann Otol Rhinol Laryngol. Nov-Dec 1986;95(6 Pt 1):576-81. [Medline].

  4. Naudo P, Laccourreye O, Weinstein G. Complications and functional outcome after supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Otolaryngol Head Neck Surg. Jan 1998;118(1):124-9. [Medline].

  5. Piquet JJ, Chevalier D. Subtotal laryngectomy with crico-hyoido-epiglotto-pexy for the treatment of extended glottic carcinomas. Am J Surg. Oct 1991;162(4):357-61. [Medline].

  6. Laccourreye H, Laccourreye O, Weinstein G, et al. Supracricoid laryngectomy with cricohyoidoepiglottopexy: a partial laryngeal procedure for glottic carcinoma. Ann Otol Rhinol Laryngol. Jun 1990;99(6 Pt 1):421-6. [Medline].

  7. Laccourreye H, Laccourreye O, Weinstein G, et al. Supracricoid laryngectomy with cricohyoidopexy: a partial laryngeal procedure for selected supraglottic and transglottic carcinomas. Laryngoscope. Jul 1990;100(7):735-41. [Medline].

  8. Chevalier D, Piquet JJ. Subtotal laryngectomy with cricohyoidopexy for supraglottic carcinoma: review of 61 cases. Am J Surg. Nov 1994;168(5):472-3. [Medline].

  9. [Guideline] Pfister DG, Laurie SA, Weinstein GS, Mendenhall WM, Adelstein DJ, Ang KK, et al. American Society of Clinical Oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer. J Clin Oncol. Aug 1 2006;24(22):3693-704. [Medline].

  10. Lai SY, Laccourreye O, Weinstein GS. Supracricoid partial laryngectomy with cricohyoidepiglottopexy. Oto HNS. (Mar) 2003;14:34-39.

  11. Majer H, Reider W. Technique de laryngecomie permetant de conserver la permeabilite respiratoiré la cricohyoido-pexie. Ann Otolaryngol Chir Cervicofac. 1959;76:677-683.

  12. Sewell DA. Supracricoid partial laryngectomy with cricohypodopexy. Oto HNSC. Mar 2003;1:27-33.

  13. Sparano A, Chernock R, Feldman M, et al. Extending the inferior limits of supracricoid partial laryngectomy: a clinicopathological correlation. Laryngoscope. Feb 2005;115(2):297-300. [Medline].

  14. Weinstein GS, Laccourreye O, Brasnu D, et al. Organ Preservation Surgery for Laryngeal Cancer. San Diego, Calif: Singular Publishing Group;2000.

  15. Weinstein GS, Laccourreye O, Rassekh C. Conservation laryngeal surgery. In: Cummings C, et al, eds. Otolaryngology: Head and Neck Surgery. 3rd ed. St Louis, Mo: Mosby-Year Book;1998.

 
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Cartilages of the larynx, posterior view.
 
 
 
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