Operative Techniques in Otolaryngology - Head and Neck Surgery最新文献

Surgery has been utilized as an approach for organ preservation of the larynx since the late 19th century, decades prior to Madame Curie's discovery of radium. But with the discovery of radium the pendulum of surgical versus nonsurgical organ preservation has swung one way or the other over the course of the 20th century. New procedures were developed during the 20th century such as the supraglottic laryngectomy to improve local control and functional outcomes. Supracricoid laryngectomy is one such procedure and can be a valuable option to preserve phonation, respiration, and swallowing function while maintaining excellent local oncologic control. This chapter reviews indications, contraindications, and anatomic considerations. Operative techniques are reviewed in detail, and outcomes and potential complications are discussed.

Total laryngectomy remains the gold standard for advanced laryngeal cancer to which all other treatments must be compared, benefiting from over 150 years of technical advancements since first performed by Theodor Billroth in 1873. The treatment paradigm has evolved with advances in both nonsurgical and surgical laryngeal preservation. The tenets of treatment, weighing oncologic outcome with functional and quality of life outcomes, have remained the same. This article reviews the history of laryngectomy, progression of surgical techniques, concurrent advancements in vocal rehabilitation, and role of complete and partial laryngectomy procedures in the current era.

Knowledge of the total laryngectomy is essential for the head & neck surgeon. While there are many indications for the procedure, it is most commonly performed for advanced squamous cell carcinoma of the larynx. This article will review common indications, basic technique, and complications of the total laryngectomy.

Imaging is critical in the evaluation and accurate staging of the patient with laryngeal cancer. Knowledge of relevant anatomy and characteristic patterns of tumor spread guides prognosis and facilitates treatment planning. Furthermore, imaging plays an important role in follow-up of the patient who has undergone successful treatment of their primary laryngeal cancer to detect recurrence and assess treatment-related complications. This review highlights the common imaging modalities used in laryngeal cancer imaging, unique anatomic considerations for each laryngeal subsite, and provides an overview of post-treatment surveillance.

Over recent decades, there has been a trend toward non-surgical or “organ preservation” therapy for advanced staged laryngeal cancers, but up to 1/3 of patients will see a lack of long-term treatment response. As a result of this paradigm shift, total laryngectomy is increasingly performed in the ‘salvage’ setting. Salvage total laryngectomy is associated with high rates of complications from impaired wound healing from prior chemotherapy and/or radiotherapy, and reconstructive techniques aim to decrease these complications. Regional and free tissue flaps are used in contemporary reconstruction of salvage laryngectomy defects. In this article, the pectoralis major myocutaneous flap and the anterolateral thigh fasciocutaneous free flap are discussed in detail. Additionally, specific techniques are described in a defect-based approach with special attention to total laryngectomy with primary closure of the mucosa, as well as defects not amenable to primary closure, such as total laryngectomy with partial or total pharyngectomy and esophagectomy. This defect-based approach allows the author to present surgical scenarios commonly encountered during salvage total laryngectomy and walk the reader through various reconstructive techniques.

As the treatment for laryngeal cancer has evolved over several decades, organ preservation has remained one of the goals of treatment. While chemoradiation therapy is the most widely used treatment modality, open surgical preservation techniques for laryngeal cancer continue to be an option in the surgeon's armamentarium. A summary of the history, anatomic considerations, principles of organ preservation and specific partial laryngectomy techniques are discussed in this review.

Surgical options for locally advanced laryngeal cancer range from organ-preservation surgeries, such as transoral laser microsurgery and partial laryngectomy, to total or near-total laryngectomy with partial or total pharyngectomy. Herein, we describe preoperative workup, surgical technique for total laryngectomy, including stomal incision and design, laryngeal framework isolation and thyroid management, entry into the larynx and pharynx, tracheoesophageal puncture, and closure options. Early and late postoperative complications are considered. Lastly, conservation laryngeal surgical options, including vertical versus horizontal partial laryngectomy and transoral laser microsurgery are discussed.

Achieving optimal voice restoration has long been the goal in total laryngectomy patients. Significantly, the achievement of a good voice has a great impact on the quality of life in this patient population. Numerous surgical and non-surgical options are available. Foremost of these is a tracheoesophageal puncture with use of a voice prosthesis. Creation of the tracheoesophageal puncture is a simple procedure which can be performed using a variety of techniques. It can also be done under general anesthesia or in the office setting. Surgical evaluation and ongoing care of the voice prosthesis is carried out in conjunction with the speech language pathologist. Most patients do well, with a variety of solutions being available for uncommon issues which may occur. In the majority of patients, alaryngeal speech is readily achievable. The head and neck surgeon should be well-versed in the techniques available.

The American Cancer Society estimates approximately 12,380 new cases of laryngeal cancer (0.7% of all cases) with approximately 3820 people dying from the disease. There is 3.86:1 male to female ratio and represent third most prevalent upper aerodigestive tract site, following the oral and pharyngeal regions. Typically affects patients in the fifth decade of life. Accurate diagnosis and management are crucial for patient survival. This study examines the pathological features of laryngectomy specimens and their significance in the diagnosis and management of laryngeal cancer. Our institution's intraoperative evaluation of margins and surgical procedures for laryngeal cancer treatment are also discussed. The study found that gross pathology and histomorphology of laryngeal specimens after laryngectomy are the most accurate methods for determining the extent of tumor involvement. The majority of our procedures involve total or partial laryngectomy. The significance of surgical pathology in the diagnosis and management of laryngeal cancer is highlighted in this article.

The treatment of laryngeal cancer requires treatment of disease with maximal preservation of laryngeal function. An array of treatments is available including endoscopic surgery, open surgery, and radiation therapy. Trans-oral laser microsurgery has become increasingly popular as data has accrued demonstrating evidence of favorable functional and oncologic outcomes.