Composite nasal septal cartilage graft for reconstruction after extended frontolateral hemilaryngectomy

With the advent of extended partial laryngectomy for T2 and selected T3 true vocal cord carcinomas, the head and neck surgeon has had to deal not only with the rehabilitation of voice, but with the problem of laryngeal stenosis with obstruction of laryngeal airflow. To manage this difficult problem, it is necessary to restore the cartilagenous superstructure to prevent collapse of the laryngeal soft tissues. This is best done at the time of initial cancer resection. At the time of extended frontal lateral hemilaryngectomy, an exact template of the resected cartilage is made. From this, a composite nasal septal cartilage graft is utilized to restore the laryngeal superstructure. The anterior commissure is reconstructed by scoring the septal cartilage. It has been our experience with this procedure that the neoglottis remains both competent and functional.