Preliminary clinical results of window partial laryngectomy: A combined endoscopic and open technique

Endoscopic laser resection for anterior commissure glottic carcinoma is dif ficult, because of inadequate exposure and close proximity to the underlyin g cartilage. A technique combining endoscopic carbon dioxide laser incision and an external approach creating a window in the thyroid cartilage was in itially tested in a canine study and then performed in 5 patients. All pati ents were men, with T1 or T2 glottic or supraglottic cancer involving the a nterior commissure, and had failed radiation treatment. The true or false v ocal fold tumors were excised along with the paraglottic space and adjacent cartilage, with preservation of the remaining thyroid framework. The recon struction was accomplished with placement of a sternohyoid muscle flap, by use of either a bipedicled muscle flap with overlying skin or a unipedicled muscle flap with a graft of free mucosa. The graft was secured in place wi th fibrin glue and laser soldering. Follow-up ranged from 11 months to 4 ye ars and included biopsies. All patients had voice recordings before and aft er surgery. A tracheostomy was avoided in all patients. The hospital stays were 4 to 13 days. The voice quality was good after surgery. One patient di ed of unrelated causes 18 months after his surgery without evidence of recu rrence. The other patients are still alive with no evidence of disease. The only complication was subcutaneous neck emphysema in 1 patient that sponta neously resolved. The results showed a satisfactory anatomic reconstruction and acceptable functions. We believe that this new combined technique is o ncologically sound, may overcome the limited access seen with the endoscopi c technique and the excessive cartilage resection seen with external partia l laryngectomy, avoids a tracheostomy, and shortens hospital stays.