Application Of Two Methods On Reconstruction Of Laryngeal Function After Partial Laryngectomy For Laryngeal Carcinoma

Objective: The laryngeal cancer is one of the most familiarmalignant tumors in head and neck region and is the third one compared to thenasopharyngeal carcinoma and the nasal carcinoma. The incidence of thedisease is the highest in the northeast of our country. Most of the patients aremen, but the cause of the disease is not clear. Along with the progress oftechnology and the improvement of medical treatment, the PartialLaryngectomy becomes the valid means which treated laryngeal cancer. On theother hand, the reconstruction of laryngeal function after partial laryngectomyfor laryngeal carcinoma is the important indicator of the partial laryngectomy’scurative effect and the patient’s living quality. At present, there are kinds ofways for partial laryngectomy, each of which has advantages and disadvantages.The main problems in the reconstruction are as follows:surgical trauma is great,operation is complicated, voice quality is poor and decannulation rate is low. Inthis study, the applications of two methods, ventricular bands and themyoperichondral flap, for laryngeal function reconstruction after partiallaryngectomy were analyzed in order to explore the treatment effect andapplication value of the ventricular bands and the myoperichondral flap in thethe reconstruction of laryngeal function after partial laryngectomy for laryngealcarcinoma. Methods: The clinical data of40cases with laryngeal cancertreated by reconstruction of laryngeal function with the ventricular bands andthe myoperichondral flap after partial laryngectomy in the department ofOtolaryngology Head and Neck Surgery in the Affiliated Hospital of LuzhouMedical College from December2011to Jan2014were retrospectivelyreviewed. The pathological diagnosis of all cases was squamous cell carcinoma.According to the results of the electronic laryngoscope, pathologicalexamination, CT and/or MRI and so on, we analyzed the basic situation of the cancer, such as tumor size, location,growth pattern, differentiation, andconfirmed the operative method. With the principle of complete excision andkeeping the normal laryngeal tissue and function as far as possible, the safemargin was confirmed by frozen section routinely during operation.Theexcision extent was extended or the operation method was changed if theexcision margin was positive. The radiotherapy after operation was considereddepending on the patient’s status. The patients were told the importance ofregular follow-up by the operator personally when discharging and followed upby rechecking electronic laryngoscope, telephone and so on in order to knowthe laryngeal cavity’s shape and the recovery information of voiced function,respiratory function and swallowing function. The complications and survivalstatus were also collected. Results:(1)39cases were male, and one was female.The age of the cases was from48to76, the median age was62. In these cases,38were glottic cancers,2was transglottic cancer. The results of TNM stagingwere as follows: T1N0M0,25cases; T1bN0M0,1case; T2N0M0,7cases; T2bN0M0,1case; T2-3N0M0,2cases; and T3N0M0,3cases; T3bN0M0,1case.(2)In the cases,21received the reconstruction of laryngeal function after partial laryngectomywith the ventricular bands,17received the reconstruction of laryngeal functionafter partial laryngectomy with the myoperichondral flap, and2cases receivedthe two methods.7cases underwent50～70Gy radiotherapy for30~40dayspostoperative2～4weeks.(3)All the cases began to take food after removingthe stomach tube without deglutition disorder.(4)The decannulation rate was97.5%(39/40).(5)All the cases restored their phonation. Although the tone waslower, deeper and hoarser compared with normal person, the normalcommunication didn’t be affected. The ratio of pronouncing well was45.0%(18/40), moderate was55.0%(22/40) and poor was0%.(6)After thepartial laryngectomy, the wound infection occurred in5cases, and3cases hadlaryngeal fistula, but no pharyngeal fistula. All patients with complicationswere cured.(7)The laryngeal cavities of the patients were spacious except1case via electronic laryngoscope examination after operation. The shape ofventricular bands was fine among these patients undertaken laryngeal functionreconstruction by moving down ventricular bands and the new glottis closedwell when pronouncing.(8)The follow-up rate was100%and there was norecurrence. All the cases felt well. Conclusions:(1)The myoperichondral flapwas thinner than the other muscle flaps, such as sternohyoid flap. Thereconstructive laryngeal cavity was spacious and decannulation rate was high.(2)Ventricular bands moving down could reconstruct glottis.The new glottisclosed well and the voice quality is well.(3)Taking positive and proper waysand keeping good communication with patients could increase thepostoperative follow-up rate, ensure the treatment effect further and improvethe survival quality.(4)The reconstruction methods of laryngeal function afterpartial laryngectomy with the ventricular bands moving down and themyoperichondral flap were convenience and the trauma were small. Theanti-infection abilities of these two flaps were strong and the wound would healquickly. It would be able to well rebuild the shape of the laryngeal cavitywhatever using these one or two reconstructive methods and keep well thephysiologic function of larynx,reduce the incidence of pharyngeal fistula anddifficulty in decannulation and pronounce. These two methods were effectivefor laryngeal functional reconstruction after partial laryngectomy.(5)Theoperation was simple, the techniques were mature and the effect of functionalreconstruction of larynx was well. It should be spread and applied in clinicalworks by using ventricular bands and the myoperichondral flap for laryngealfunction reconstruction after partial laryngectomy in patients sufferinglaryngeal cancer.