Framework invasion by laryngeal carcinomas

The accuracy of standard clinical and radiologic methods in detecting invasion of the laryngeal framework or the presence of a transglottic tumor was examined by comparing clinical and pathologic findings in a series of 50 randomly selected laryngectomies for squamous carcinoma. Forty-two of the patients had received radiation therapy as primary treatment. The presence of pain referred to the ear immediately before laryngectomy indicated invasion of the laryngeal framework or spread into the extralaryngeal soft tissues in 11 of 12 patients. Transglottic tumors were correctly identified in 10 of 14 patients from laryngeal tomograms, but seven additional tumors were incorrectly designated as transglottic. Both transglottic tumors and infraglottic extension were seriously underdiagnosed by direct laryngoscopy. Framework invasion was seen to be a feature of transglottic tumors 2 cm or more in diameter. The morphology of this process is described. Limited follow-up has already shown a pattern of early recurrence, frequently as cervical node metastases, that is significantly more common in patients with framework invasion.