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Reconstruction of the glottis by composite nasal septal graft
P112
Instruction Courses-- Monday
COURSE 2842-1 One-period course ($20)
Room NOCC-Ballroom A 4:15-5:15
Reconstruction of the Glottis by Composite Nasal Septal Graft YUVAL ZOHAR, MD Petah Tiqva, Israel
Educational objectives: To review the indication of partial vertical laryngectomies for carcinoma of the anterior commissure of the larynx and selected Tl of the vocal cords, and to acquire a better understanding of how to use the nasal septal graft in the glottis reconstruction.
Carcinoma of the anterior commissure (AC), or extending to the AC, of the larynx presents specific problems related to the anatomic details that have to be remembered by the surgeon for adequate treatment. We consider that any lesion within 3 mm of the anterior limit of the cord carries a high risk of AC involvement. Specialists in the field demonstrated by serial sections the high incidence of submucosal spread beneath normal-appearing mucosa. For that particular reason, we recommend conservation surgery as a primary treatment modality in carcinoma of the AC or
Otolaryngology Head and Neck Surgery May 1995
extending to the AC. This course will attempt to address the current conservation surgical option and glottic reconstruction using the composite nasal-septal mucoperichondrial graft. Criteria for patients' selection were: (1) lesion involving the AC, (2) lesion involving the AC and half or more of one vocal cord, and (3) lesion involving the AC and one vocal cord within 3 mm of the AC. In our series of 34 nonirradiated patients treated by partial laryngectomy, the 5-year free of disease rate was 95%. The operative technique consisted in: (1) tracheostomy, (2) prelevation of the nasal septal cartilage graft covered only on one side by its muco-perichondrium, through a retrocollumelar incision, (3) frontal or frontolateral laryngectomy, according to the oncologic findings, with preservation of the external perichondrium, and (4) wedging and suturing of the nasal septal cartilage graft in the laryngeal defect. A normal width of laryngeal lumen should be obtained. This technique of reconstruction of the larynx enhances the surgeon's ability and strengthens his conviction to proceed to enlarged partial laryngectomy. The indications, limitations, and surgical technique for this procedure will be presented in detail.
Instruction Courses-- Monday
COURSE 2842-1 One-period course ($20)
Room NOCC-Ballroom A 4:15-5:15
Reconstruction of the Glottis by Composite Nasal Septal Graft YUVAL ZOHAR, MD Petah Tiqva, Israel
Educational objectives: To review the indication of partial vertical laryngectomies for carcinoma of the anterior commissure of the larynx and selected Tl of the vocal cords, and to acquire a better understanding of how to use the nasal septal graft in the glottis reconstruction.
Carcinoma of the anterior commissure (AC), or extending to the AC, of the larynx presents specific problems related to the anatomic details that have to be remembered by the surgeon for adequate treatment. We consider that any lesion within 3 mm of the anterior limit of the cord carries a high risk of AC involvement. Specialists in the field demonstrated by serial sections the high incidence of submucosal spread beneath normal-appearing mucosa. For that particular reason, we recommend conservation surgery as a primary treatment modality in carcinoma of the AC or
Otolaryngology Head and Neck Surgery May 1995
extending to the AC. This course will attempt to address the current conservation surgical option and glottic reconstruction using the composite nasal-septal mucoperichondrial graft. Criteria for patients' selection were: (1) lesion involving the AC, (2) lesion involving the AC and half or more of one vocal cord, and (3) lesion involving the AC and one vocal cord within 3 mm of the AC. In our series of 34 nonirradiated patients treated by partial laryngectomy, the 5-year free of disease rate was 95%. The operative technique consisted in: (1) tracheostomy, (2) prelevation of the nasal septal cartilage graft covered only on one side by its muco-perichondrium, through a retrocollumelar incision, (3) frontal or frontolateral laryngectomy, according to the oncologic findings, with preservation of the external perichondrium, and (4) wedging and suturing of the nasal septal cartilage graft in the laryngeal defect. A normal width of laryngeal lumen should be obtained. This technique of reconstruction of the larynx enhances the surgeon's ability and strengthens his conviction to proceed to enlarged partial laryngectomy. The indications, limitations, and surgical technique for this procedure will be presented in detail.