The management of advanced subglottic carcinoma with stomal invasion: a case report

Primary subglottic carcinoma is rare. The initial stage is usually asymptomatic and the carcinoma is advanced when the symptoms are in evidence. Because the trachea and thyroid gland adjoin to the subglottic area, the tumor invades them along with the superior mediastinum and lung by the way of paratracheal lymph drainage. To resuscitate a severe airway obstruction, an emergency tracheotomy is required, which, however, results in a higher frequency of stomal recurrence later. We treated a case with advanced subglottic carcinoma and performed extended radical neck dissection with the resection of total larynx, thyroid gland, and involved trachea with peristomal skin en bloc. In order to completely remove the paratracheal and superior mediastinal lymph nodes, the sternal manubrium and its adjoining clavicles and ribs were cut off. This was necessary to optimize the field of vision, and to prevent injury to the great vessels and pleura. Because of its availability, its thickness, and its skin paddle, the pectoralis major myocutaneous flap was formed to the skin defect and to protect the great vessels. Postoperative stoma was at the sternal level and did not compress the great vessels. Parathyroid gland, after chopping, was reimplanted into muscle tissue to prevent hypocalcemia. No more postoperative radiotherapy or chemotherapy was necessary because the lymph nodes were spared. There were no postoperative complications and the patient was discharged 2 weeks later. No recurrence occurred in the 28 months follow-up period.