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[Computerized tomography in the evaluation of the larynx after surgical treatment and irradiation]
Introduction:
The follow-up of the patients submitted to surgery for laryngeal carcinoma requires both clinical and CT examinations, particularly in the cases at high risk of recurrence. Our series consisted of 72 laryngeal carcinoma patients operated on and regularly followed-up with CT to distinguish relapse from normal or abnormal postoperative changes.
Materials And Methods:
Seventy-two laryngeal carcinoma patients were submitted to surgery: total laryngectomy was performed in 33 cases, supraglottic laryngectomy in 16 cases, Labayle subtotal laryngectomy in 18 cases and Mayer Piquet subtotal laryngectomy in 5 cases. The patients were followed-up postoperatively with CT and 94 examinations were performed in all; pathology was performed in all the cases with radiologic suspicion of recurrence (19 patients) and further clinical examinations were performed to exclude recurrence in the 14 cases where imaging findings were questionable.
Results And Discussion:
Local recurrences were confirmed in 16 of 19 patients with positive CT findings. Radiologically, the recurrence appeared as an irregular thickening of the pharyngo-laryngeal wall with inhomogeneous density after i.v. contrast agent infusion. The patients submitted to total or supraglottic laryngectomy recurred most often at the cranial site of resection (5/6 cases), those submitted to Labayle surgery at the mucosa adjacent to the cricoarytenoid unit (3/3 cases) and those submitted to Mayer Piquet surgery in the supraglottic region. Two more patients submitted to emergency tracheotomy recurred at this level. Lymph node recurrences were found in 6 total laryngectomy patients. Misinterpretations were most frequently due to postirradiation changes (5 of 14 cases) or to atypical postoperative images (4/14 cases). Three more patients presented a secondary lesion misinterpreted as a relapse.
Conclusions:
Our results confirm the role of CT in the follow-up of the patients operated on for laryngeal carcinoma when CT findings are closely correlated with clinical and endoscopic results, permitting to correctly assess the extent of relapse and possible nodal spread.