Role and limitations of vertical hemilaryngectomy

Two types of vertical hemilaryngectomy are discussed. The frontolateral operation is indicated for infiltrating lesions of the cord, anterior to the vocal process, which approach or involve the anterior commissure. It should not be used for carcinomas which extend posteriorly beyond the tip of the vocal process, into the ventricle or below the inferior surface of the cord. The "extended" frontolateral operation is useful for infiltrative cordal lesions showing (1) posterior extension to or beyond the tip of the vocal process, but not into the posterior commissure, (2) beginning impairment of motility without actual fixation of the cord, (3) limited and superficial extension to the ventricle or margin of the ventricular band, or (4) subglottic extension amounting to no more than a few millimeters. The lesions are removed en bloc, along with a large portion of the thyroid cartilage and usually the entire arytenoid. Accurate delineation of the gross extent of the lesion is essential if these techniques are to be successfully applied. Failures are likely if attempts are made to over-extend the indications.