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

182

THE LARYNX, BRONCHI AND OESOPHAGUS

metastases in the transglottic group. Since subglottic extension is so important
in the prognosis all cases in the transglottic group should have tomograms or
laryngograms.

TREATMENT. If no cartilage is involved a cure should be achieved with
radiotherapy in over 90 per cent of cases. If cartilage is involved radiotherapy
may also be used and an expectant policy adopted. If no recurrence occurs, the
patient will have a good voice, but if there is a recurrence surgery will be
necessary. Either a hemilaryngectomy or a total laryngectomy may be
offered. A hemilaryngectomy (Figs. 86-89) involves removing half of the
thyroid cartilage with the false and true vocal cords, part of the supraglottis
and the upper half of the cricoid cartilage. The resulting gap is closed by the
strap muscles fashioned so as to form a new fixed vocal cord. The results of this

Fig. 88. Hemilaryngectomy. After the hemi-
larynx is removed the muscles are repositioned
as shown. 4 is pericbondrial flap.

Fig. 89. Hemilaryngectomy. The perichondrial
flap is replaced and sutured to the remaining
lamina.

as a primary operation for glottic tumours affecting cartilage are better than
those from radiotherapy. If a hemilaryngectomy is used as a salvage procedure
after failed radiotherapy the results will be poorer than if it had been used as a
primary treatment. It does, however, give the patient a chance of keeping
some sort of voice instead of having to learn oesophageal speech after a total
laryngectomy.

TRANSGLOTTIC TUMOURS

These seldom present until they are large and have palpable cervical gland meta-
stases. The most satisfactory treatment is total laryngectomy with a radical
neck dissection if glands are palpable. A total laryngectomy (Fig. 90) involves
removing the hyoid, thyroid and cricoid cartilages and several tracheal rings.
When this is removed the pharynx is left open from the base of the tongue to
the mouth of the oesophagus, and this is repaired in layers to form a new