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Management of the anterior commissure lesion by combining anterior partial resection and CO2 laser excision
International Congress Series 1240 (2003) 767
Management of the anterior commissure lesion by combining anterior partial resection and CO2 laser excision Magid El Shennawy * ENT Department, Cairo University, Cairo, Egypt
Carcinoma involving the anterior commissure presents unique problems that make treatment difficult. Pretreatment assessment of the extent of the tumor is not entirely satisfactory by any modality. Resection of the anterior commissure with varying degree of the adjacent vocal cord requires modification of the standard vertical laryngectomy. It is mandatory to remove thyroid cartilage in the region overlying the anterior commissure, but it is possible to make the internal soft tissue margins more posterior than the cartilage itself. Technically, once the larynx has been exposed, the thyroid perichondrium is incised vertically in the midline and elevated bilaterally to almost the posterior edge of the thyroid cartilage. Vertical thyrotomies are created with an oscillating saw to spare as much cartilage as possible and allowing for adequate margins. A horizontal incision is made above the cricoid cartilage and is carried through the cricothyroid membrane to the thyrotomy on the side of least tumor involvement. The author’s modification is to bring the operating microscope coupled with CO2 laser arm to look through the hole in the cricothyroid membrane, and double hooks are utilized for retraction. With the help of the micromanipulator, the endolaryngeal mucosal incisions are made under magnification with CO2 laser in a cutting mode. The tumor is removed with adequate safety margins including the anterior parts of both vocal cords. Recreation of a new anterior commissure is accomplished by the use of a composite nasal septal graft. The graft is sutured into position with the mucosa covering it facing endolarynx. External perichondrium of the larynx is closed over graft. The epiglottis has been used to reconstruct defects of the anterior commissure as a well-vascularized advancement flap that functions dynamically. * Fax: +20-202-361-3173. E-mail address: [email protected] (M. El Shennawy). 0531-5131/ D 2003 International Federation of Otorhinolaryngological Societies (IFOS). All rights reserved. doi:10.1016/S0531-5131(03)00832-X
Management of the anterior commissure lesion by combining anterior partial resection and CO2 laser excision Magid El Shennawy * ENT Department, Cairo University, Cairo, Egypt
Carcinoma involving the anterior commissure presents unique problems that make treatment difficult. Pretreatment assessment of the extent of the tumor is not entirely satisfactory by any modality. Resection of the anterior commissure with varying degree of the adjacent vocal cord requires modification of the standard vertical laryngectomy. It is mandatory to remove thyroid cartilage in the region overlying the anterior commissure, but it is possible to make the internal soft tissue margins more posterior than the cartilage itself. Technically, once the larynx has been exposed, the thyroid perichondrium is incised vertically in the midline and elevated bilaterally to almost the posterior edge of the thyroid cartilage. Vertical thyrotomies are created with an oscillating saw to spare as much cartilage as possible and allowing for adequate margins. A horizontal incision is made above the cricoid cartilage and is carried through the cricothyroid membrane to the thyrotomy on the side of least tumor involvement. The author’s modification is to bring the operating microscope coupled with CO2 laser arm to look through the hole in the cricothyroid membrane, and double hooks are utilized for retraction. With the help of the micromanipulator, the endolaryngeal mucosal incisions are made under magnification with CO2 laser in a cutting mode. The tumor is removed with adequate safety margins including the anterior parts of both vocal cords. Recreation of a new anterior commissure is accomplished by the use of a composite nasal septal graft. The graft is sutured into position with the mucosa covering it facing endolarynx. External perichondrium of the larynx is closed over graft. The epiglottis has been used to reconstruct defects of the anterior commissure as a well-vascularized advancement flap that functions dynamically. * Fax: +20-202-361-3173. E-mail address: [email protected] (M. El Shennawy). 0531-5131/ D 2003 International Federation of Otorhinolaryngological Societies (IFOS). All rights reserved. doi:10.1016/S0531-5131(03)00832-X