Supracricoid Partial Laryngectomies
Feb 21, 2009
The Supracricoid Partial Laryngectomies (SCPL) are a subset of surgical procedures that are available to the Head and Neck Surgeon for the management of selected cancers of the larynx. The SCPLs are a subset of conservation laryngeal operations.
SCPL refers to the resection of the diseased or affected part of the larynx that is removed at the time of operation. The defect in the larynx is then reconstructed at the time of operation with what is known as a crico-hyoidal impaction. The specific type of impaction is either a cricohyoidoepiglottopexy, a cricohyoidopexy, or a tracheocricohyoidoepiglottopexy. Exactly which reconstruction is used is determined by the location of the patient’s cancer, the extent of involvement of the tumor and the patient's overall condition. The SCPLs are all alike in that the anterior component of the vocal cords is removed bilaterally in addition to the immediate area above and below the vocal cords. If the tumor then extends either above or below the actual vocal cords (or glottis), then either of the above reconstructions is performed. In addition, one of the arytenoids (the cartilage that controls the vocal cords) can also be removed.
The benefits of the SCPLs are that rather large tumors can be effectively removed from the larynx while still preserving swallowing, speech and the airway functions of the larynx. While the patient's voice will never be normal after any of the supracricoid partial laryngectomies, the patient is able to communicate readily without the aid of any prosthesis or electronic device, and most importantly, the vast majority of patients do not need a permanent tracheostomy. A tracheostomy is necessary in the immediate post-operative period, but we are usually able to remove this in the few days after surgery, before the patient even leaves the hospital. Then, as the surgery and tracheostomy sites heal, the patient relearns how to speak and swallow. Obviously then, if we can avoid the permanent hole in the neck needed with more traditional laryngeal surgeries, then the patient can lead a more normal and active life with fewer, if any, restrictions.
The SCPLs do, however, have some contraindications. Not everyone is a candidate for conservation laryngeal surgeries, and very specific criteria have to be met to be able to perform the resection and reconstruction while still removing the entire tumor. Obviously, the first goal of any cancer operation is to remove all of the cancer. In addition, pulmonary function must be assessed before performing any of the above surgeries. While patients recuperate from their surgery, there is often a moderate amount of aspiration of saliva and even diet into the airway. While the patient relearns to swallow in usually no more than seven to ten days, it is important that he have healthy lungs so that he can tolerate this small degree of aspiration. In addition, SCPLs do not give patients a normal voice. Patients are, however, able to communicate readily and without the use of any assisted devices.
Once a patient is found to have cancer of the larynx, it is then up to his treating surgeon to assess the extent of the disease and consider the patient's surgical options. If SCPL is an option, then we like to use it as we feel that not only is the patient’s long-term function significantly improved as compared to traditional therapy but also long-term cancer control is not sacrificed.
SCPL refers to the resection of the diseased or affected part of the larynx that is removed at the time of operation. The defect in the larynx is then reconstructed at the time of operation with what is known as a crico-hyoidal impaction. The specific type of impaction is either a cricohyoidoepiglottopexy, a cricohyoidopexy, or a tracheocricohyoidoepiglottopexy. Exactly which reconstruction is used is determined by the location of the patient’s cancer, the extent of involvement of the tumor and the patient's overall condition. The SCPLs are all alike in that the anterior component of the vocal cords is removed bilaterally in addition to the immediate area above and below the vocal cords. If the tumor then extends either above or below the actual vocal cords (or glottis), then either of the above reconstructions is performed. In addition, one of the arytenoids (the cartilage that controls the vocal cords) can also be removed.
The benefits of the SCPLs are that rather large tumors can be effectively removed from the larynx while still preserving swallowing, speech and the airway functions of the larynx. While the patient's voice will never be normal after any of the supracricoid partial laryngectomies, the patient is able to communicate readily without the aid of any prosthesis or electronic device, and most importantly, the vast majority of patients do not need a permanent tracheostomy. A tracheostomy is necessary in the immediate post-operative period, but we are usually able to remove this in the few days after surgery, before the patient even leaves the hospital. Then, as the surgery and tracheostomy sites heal, the patient relearns how to speak and swallow. Obviously then, if we can avoid the permanent hole in the neck needed with more traditional laryngeal surgeries, then the patient can lead a more normal and active life with fewer, if any, restrictions.
The SCPLs do, however, have some contraindications. Not everyone is a candidate for conservation laryngeal surgeries, and very specific criteria have to be met to be able to perform the resection and reconstruction while still removing the entire tumor. Obviously, the first goal of any cancer operation is to remove all of the cancer. In addition, pulmonary function must be assessed before performing any of the above surgeries. While patients recuperate from their surgery, there is often a moderate amount of aspiration of saliva and even diet into the airway. While the patient relearns to swallow in usually no more than seven to ten days, it is important that he have healthy lungs so that he can tolerate this small degree of aspiration. In addition, SCPLs do not give patients a normal voice. Patients are, however, able to communicate readily and without the use of any assisted devices.
Once a patient is found to have cancer of the larynx, it is then up to his treating surgeon to assess the extent of the disease and consider the patient's surgical options. If SCPL is an option, then we like to use it as we feel that not only is the patient’s long-term function significantly improved as compared to traditional therapy but also long-term cancer control is not sacrificed.
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