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Perichondrial flap to prevent chondritis and cartilage necrosis in salvage vertical partial laryngectomy for recurrent glottic carcinoma after irradiation: A new procedure

 Young Chang Lim  ;  Eun Jin Son  ;  Kyubo Kim  ;  Kwang Moon Kim  ;  Eun Chang Choi 
 ACTA OTO-LARYNGOLOGICA, Vol.125(6) : 659-663, 2005 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell/radiotherapy ; Carcinoma, Squamous Cell/surgery* ; Cartilage Diseases/prevention & control* ; Cricoid Cartilage/pathology* ; Cricoid Cartilage/radiation effects ; Cricoid Cartilage/surgery ; Deglutition/physiology ; Fasciotomy ; Follow-Up Studies ; Glottis/radiation effects ; Glottis/surgery* ; Humans ; Laryngeal Diseases/prevention & control* ; Laryngeal Muscles/surgery ; Laryngeal Neoplasms/radiotherapy ; Laryngeal Neoplasms/surgery* ; Laryngectomy/rehabilitation* ; Male ; Middle Aged ; Necrosis ; Neoplasm Recurrence, Local/surgery* ; Retrospective Studies ; Surgical Flaps* ; Suture Techniques ; Thyroid Cartilage/pathology* ; Thyroid Cartilage/radiation effects ; Thyroid Cartilage/surgery ; Time Factors ; Tracheostomy/instrumentation ; Vocal Cords/radiation effects ; Vocal Cords/surgery
Chondritis ; perichondrial flap ; radiation ; vertical partial laryngectomy
CONCLUSION: We conclude that our new closure method using the posterior- and inferior-based perichondrial flap may diminish the chance of development of chondritis in salvage vertical partial laryngectomized patients with recurrent glottic cancer.
OBJECTIVE: Post-radiation laryngeal chondritis with resultant cartilage necrosis is one of the most dreaded complications of radiotherapy treatment of glottic carcinoma. In the case of salvage vertical partial laryngectomy, the risk of its development may be increased. We introduce a new posterior- and inferior-based perichondrial flap procedure to prevent postoperative chondritis after salvage vertical partial laryngectomy.
MATERIAL AND METHODS: The perichondrium is incised along the midline and upper border of the thyroid cartilage, but not along the inferior border, unlike the conventional method. Then, the posterior- and inferior-based perichondrial flap, along with the cricothyroid muscle fascia, is elevated from the midline. For closure of the pharyngeal lumen, the outer perichondrium of the lesion side is sutured to the inner perichondrium of the contralateral side to protect the larynx from pharyngeal secretion. The utility of this procedure is reviewed retrospectively in 10 patients with locally persistent or recurrent squamous cell carcinoma of the vocal cord after failed laryngeal radiation therapy between 1994 and 2001.
RESULTS: None of our patients developed chondritis postoperatively. The interval between the operation and removal of the tracheostomy tube ranged from 8 to 23 days (mean 12 days). Patients were able to swallow without aspiration within 7-22 days of the operation (mean 10 days). Discharge from hospital was possible after a mean recovery period of 11 postoperative days.
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1. College of Medicine (의과대학) > Dept. of Otorhinolaryngology (이비인후과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kwang Moon(김광문)
Son, Eun Jin(손은진)
Choi, Eun Chang(최은창)
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