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

Abstract

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.