Supracricoid Laryngectomy Workup

Updated: Feb 11, 2016
  • Author: Stephen Y Lai, MD, PhD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

Imaging Studies

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  • 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

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  • 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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