[Study of reserving unilateral arytenoid cartilage to improve voice quality in supracricoid partial laryngectomy with anastomosis of cricoid cartilage, base of tongue and epiglottis].

OBJECTIVE

To study the surgical technique of reserving unilateral arytenoid cartilage and the effects on improving voice quality in supracricoid partial laryngectomy with anastomosis of cricoid cartilage,base of tongue and epiglottis.

METHOD

Twenty-six glottic carcinomas (T1b 11 cases,T2 12 cases, T3 3 cases ) were summarized from Jan. 1995 to Oct. 2003. Both vocal cords were affected. On arytenoid reserved side, invasion of vocal cord was below 2/3 and there was 3 mm safety distance to vocal process; also posto-inferior 1/3 part of thyroid cartilage was preserved to prevent injury of laryngeal recurrent nerve and assure normal motion of arytenoid cartilage. On non- reserved side, the half larynx was excised completely. Anastomosis of cricoid cartilage,base of tonge and epiglottis was used to reconstruct laryngeal function.

RESULT

All cases restored their normal swallow during postoperative 7 to 23 days. Twenty-five cases were decannulated and the decannulation rate was 96.1% (25/26). All cases restored phonation. Different degree of hoarseness existed. In 18 cases the loudness of voice made them be competent for indoor communication and the speech could be easily understood; in 8 cases the loudness of voice made them be able to communicate within 1 meter distance and the speech could be understood under quiet circumstance. There were no pharyngeal fistula and pulmonary complications. Local infection was found in 2 cases and cured in 7 days. Local recurrence and cervical lymph node metastasis rate were 3.8% (1/26), 3.8% (1/26) respectively. Lost patients were assumed to death and direct method was used to calculate survival rate. In 17 patients postoperative period was above 3 years, 1 died in 3 years and 1 was lost. 3-year survival rate was 88.2% (15/17). In 10 patients postoperative period was above 5 years and 2 died in 5 years. 5-year survival rate was 80.0% (8/10).

CONCLUSION

In selected cases with invasion of both vocal cords, unilateral arytenoid cartilage can be reserved and it will be helpful to improve voice quality. The active motion of arytenoid cartilage toward antero-median position and the corresponding motion of epiglottis maybe the reason to improve voice quality.