Imaging Studies

See the list below:

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.

Diagnostic Procedures

See the list below:

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.

Treatment & Management

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. 2011 May. 33(5):679-85. [QxMD MEDLINE Link].
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. 2009 Nov. 135(11):1154-7. [QxMD MEDLINE Link].
Hirano M, Kurita S, Kiyokawa K, Sato K. Posterior glottis. Morphological study in excised human larynges. Ann Otol Rhinol Laryngol. 1986 Nov-Dec. 95(6 Pt 1):576-81. [QxMD MEDLINE Link].
Leszczynska M, Wierzbicka M, Tokarski M, Szyfter W. Attempt to improve functional outcomes in supracricoid laryngectomy in T2b and T3 glottic cancers. Eur Arch Otorhinolaryngol. 2014 Aug 21. [QxMD MEDLINE Link].
Mannelli G, Meccariello G, Deganello A, Fiorini FR, Paiar F, Gallo O. Subtotal supracricoid laryngectomy: changing in indications, surgical techniques and use of new surgical devices. Am J Otolaryngol. 2014 Jul 21. [QxMD MEDLINE Link].
Naudo P, Laccourreye O, Weinstein G. Complications and functional outcome after supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Otolaryngol Head Neck Surg. 1998 Jan. 118(1):124-9. [QxMD MEDLINE Link].
Piquet JJ, Chevalier D. Subtotal laryngectomy with crico-hyoido-epiglotto-pexy for the treatment of extended glottic carcinomas. Am J Surg. 1991 Oct. 162(4):357-61. [QxMD MEDLINE Link].
Laccourreye H, Laccourreye O, Weinstein G, et al. Supracricoid laryngectomy with cricohyoidoepiglottopexy: a partial laryngeal procedure for glottic carcinoma. Ann Otol Rhinol Laryngol. 1990 Jun. 99(6 Pt 1):421-6. [QxMD MEDLINE Link].
Laccourreye H, Laccourreye O, Weinstein G, et al. Supracricoid laryngectomy with cricohyoidopexy: a partial laryngeal procedure for selected supraglottic and transglottic carcinomas. Laryngoscope. 1990 Jul. 100(7):735-41. [QxMD MEDLINE Link].
Chevalier D, Piquet JJ. Subtotal laryngectomy with cricohyoidopexy for supraglottic carcinoma: review of 61 cases. Am J Surg. 1994 Nov. 168(5):472-3. [QxMD MEDLINE Link].
[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. 2006 Aug 1. 24(22):3693-704. [QxMD MEDLINE Link].
Lai SY, Laccourreye O, Weinstein GS. Supracricoid partial laryngectomy with cricohyoidepiglottopexy. Oto HNS. 2003 (Mar). 14:34-39.
Majer H, Reider W. Technique de laryngecomie permetant de conserver la permeabilite respiratoiré la cricohyoido-pexie. Ann Otolaryngol Chir Cervicofac. 1959. 76:677-683.
Sewell DA. Supracricoid partial laryngectomy with cricohypodopexy. Oto HNSC. 2003 Mar. 1:27-33.
Sparano A, Chernock R, Feldman M, et al. Extending the inferior limits of supracricoid partial laryngectomy: a clinicopathological correlation. Laryngoscope. 2005 Feb. 115(2):297-300. [QxMD MEDLINE Link].
Weinstein GS, Laccourreye O, Brasnu D, et al. Organ Preservation Surgery for Laryngeal Cancer. San Diego, Calif: Singular Publishing Group. 2000.
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.

Media Gallery

Cartilages of the larynx, posterior view.

of 1

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, Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Received grant/research funds from GlaxoSmithKline for none; Received grant/research funds from Neoprobe for 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 Head and Neck Society, American Laryngological Association, American Radium Society, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of University Otolaryngologists-Head and Neck Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, The Triological Society, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Nader Sadeghi, MD, FRCSC Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, McGill University Faculty of Medicine; Chief Otolaryngologist, MUHC; Director, McGill Head and Neck Cancer Program, Royal Victoria Hospital, Canada

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, Royal College of Physicians and Surgeons of Canada

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Merck.

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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

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, The Triological Society

Disclosure: Nothing to disclose.

Supracricoid Laryngectomy Workup

Imaging Studies

Diagnostic Procedures

References

Tables

Contributor Information and Disclosures

What would you like to print?