Vertical Partial Laryngectomy Workup
- Author: Christopher Klem, MD; Chief Editor: Arlen D Meyers, MD, MBA more...
Laboratory studies are not generally required for VPL except as indicated to evaluate any comorbid conditions. Some physicians perform a metastatic screen to look for evidence of tumor spread to lung, liver, or bone, but the yield of these tests on small tumors amenable to VPL is low.
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- Imaging studies are not usually required except to assess patients for comorbid conditions or synchronous primary cancers. In such cases, a chest radiograph (CXR) is indicated.
- Barium swallow should be considered in symptomatic patients.
- A neck CT scan should be considered to evaluate thyroid cartilage invasion in patients with anterior commissure involvement.
- A CT scan of the head and neck with fine cuts (1 mm) through the larynx should be considered in patients with vocal cord impairment or fixation.
Other tests are needed to assess operative risk as indicated for comorbid conditions.
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- Diagnostic tests include flexible laryngoscopy in the office to assess vocal cord and arytenoid mobility and the extent of the lesion.
- A thorough head and neck examination should be performed.
- Panendoscopy to exclude synchronous malignancy in the head and neck, tracheobronchial tree, and esophagus is controversial, but should be performed in most cases.
- Preoperative and postoperative videostroboscopy and voice recording for functional assessment and documentation are important parts of patient evaluation and care.
The histology of initial tumors usually reveals squamous cell carcinoma arising from dysplasia. Minor salivary carcinomas, most commonly adenoid cystic carcinoma, are rare. Small cell carcinoma, other neuroendocrine tumors, and sarcoma are extremely rare. Granular cell tumors, plasmacytoma, and other lesions that resemble malignancy should also be considered in the differential diagnoses.
Recurrences following radiotherapy are histologically characterized by small nests of neoplastic cells lying deep below intact mucosa. Most recurrent carcinomas present with multicentric tumor foci, whereas most primary carcinomas present with a central tumor location. Marked perineural infiltration has lead to the hypothesis that recurrent tumors grow alongnerves involving previously unaffected areas.
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