Lateral supraglottic pharyngo-laryngectomy with arytenoidectomy

Supraglottic laryngectomy for tumors of the epilarynx requiring arytenoid cartilage resection is frequently associated with problems in relearning to swallow, and aspiration is frequent. We propose a surgical procedure in which a local flap is used to close the pharyngeal defect.

An apron skin incision is used to expose the hyoid bone and strap muscles. The median raphe is opened, and the hyoid bone is cut along the midline and released on its posterior surface. The thyrohyoid and stemothyroid muscles ipsilateral to the tumor are separated, with the perichondrium from the thyroid cartilage. This forms a continuous flap that includes the suprahyoid muscles and hemihyoid bone, together with the strap muscles and thyroid lobe that will be used for closure.

Thirty-three patients with T1-T3 carcinomas of the laryngeal margin, with extension to one arytenoid in all cases and to the pyriform fossa in 14, underwent this procedure. Only 5/33 (15%) patients had locoregional recurrences. Visceral metastases occurred in 11/33 (33%) patients, and second primary tumors were diagnosed at the time of surgery or during follow-up in 9/33 (27%) patients. Three-year and 5-year actuarial survival rates were 57% and 51%, respectively. Despite the need for radiotherapy in 26 patients, functional success was obtained in 26/33 cases (79%).

This technique provided good tumor control and a high rate of satisfactory functional results. It can be applied to patients with tumors of the lateral margin which unilaterally extend to the aryepiglottic fold, the arytenoid, and the medial well of the pyriform fossa.