Subtotal laryngectomy with myomucosal shunt

Area of Science:

• Otolaryngology
• Surgical Oncology
• Speech Pathology

Background:

• Laryngeal cancer treatment often requires total laryngectomy, leading to voice loss.
• Subtotal laryngectomy techniques aim to preserve laryngeal function.
• Developing functional voice restoration after laryngeal surgery remains a challenge.

Purpose of the Study:

• To describe a modified subtotal laryngectomy technique.
• To evaluate the efficacy of this technique in voice production and prevention of aspiration.
• To assess oncological outcomes in patients undergoing this procedure.

Main Methods:

• A modified subtotal laryngectomy preserving posterior structures and neurovascular supply.
• Creation of an endolaryngeal myomucosal shunt continuous with the trachea.
• Patient selection based on tumor extent, confirmed intraoperatively with frozen sections.
• Finger occlusion of the tracheal stoma to direct airflow through the shunt.
• Thyroarytenoid muscle constriction for a valved shunt.

Main Results:

• Eleven patients with squamous cell carcinoma (some previously irradiated) underwent the procedure.
• All patients achieved satisfactory voice production.
• No local recurrence was observed in any patient.
• One patient experienced a temporary aspiration problem that later resolved.

Conclusions:

• This modified subtotal laryngectomy technique effectively restores voice.
• The myomucosal shunt procedure prevents aspiration and achieves favorable oncological outcomes.
• Careful patient selection and intraoperative assessment are crucial for eliminating residual tumor.