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Full text of "Diseases Of The Nose Throat And Ear"

180

THE LARYNX, BRONCHI AND OESOPHAGUS

10 per cent better than radiotherapy but the 50 per cent who were cured by
radiotherapy retained a good voice.

Supraglottic laryngectomy (Fig. 84) was fully developed in the 1960s and it
involves removing the entire supraglottis, from the vallecula to the ventricle,
and joining the lower half of the larynx to the base of the tongue using a
perichondrial flap (Fig. 85). The resultant proximity of the vocal cords to the
base of the tongue makes swallowing a little difficult so the mouth of the
oesophagus has to be widened by a cricopharyngeal myotomy. This operation

Fig. 84. 1, Showing the area of larynx to be
removed; 2, Site of the cricopharyngeal
myotomy; 3, Perichondrial flap.

Fig. 85. After removal of the specimen the
perichondrial flap (3) is sutured to the base of
the tongue (1) and supported by the strap
muscle layer (4). A cricopharyngeal myotomy
is done over a distance of 5 cm (2).

allows the patient to retain a normal voice and gives about an 80 per cent
5-year cure (i.e. 30 per cent better than radiotherapy). If the tumour involves
the tongue, the pyriform sinus or the vocal cords the operation should not be
done, nor should it be done if the patient is over 65, or if he has a bad chej^j
In all of these conditions the postoperative dysphagia will be of such sevesB
that repeated aspirations may be fatal.                                                   flj

At one time the accepted procedure was to do a radical neck dissection^
every patient on the assumption that the high incidence of metastatic glands
made it likely that most patients had at least non-palpable metastases, Time
showed, however, that the result of this policy gave no advantage over doing a
radical neck dissection only in those cases with palpable glands, or doing a
radical neck dissection as a second stage if and when glands became palpable.

GLOTTIC CANCER

PATHOLOGY. The glottis extends from the anterior to the posterior commissure.
It consists of both cartilage and membraneŚcartilage forming the posterior