Oppenheimer R W, Krespi Y P, Einhorn R K
Department of Otolaryngology, SUNY-Health Sciences Center, Brooklyn 11203.
Head Neck. 1989 May-Jun;11(3):252-6. doi: 10.1002/hed.2880110311.
Radiation necrosis of the laryngeal cartilages is an uncommon complication of radiotherapy for laryngeal carcinoma. It is a devastating process for which there is no one acceptable treatment. Medical management offers only temporary, symptomatic relief, which further necessitates surgical treatment. Surgical management may start with a tracheotomy; however, it often ends with a total laryngectomy. Physiologically, the necrotic cartilages are the source of the problem. It is a general surgical principle that nonviable tissue must be excised to promote healing. Therefore, if the affected laryngeal cartilages were removed, the larynx should heal. Total or near total removal of the thyroid and cricoid cartilages with preservation of the endolaryngeal soft tissues has not been reported in the literature. Theoretically, if the entire cartilaginous framework is removed, there would be no structural support for the airway. We have found using animal models, that submucosal resection of the laryngeal cartilages, leaving the perichondrium and endolaryngeal soft tissues intact can result in a competent airway. Animal and clinical experience will be presented.
喉软骨放射性坏死是喉癌放射治疗中一种罕见的并发症。这是一个极具破坏性的过程，目前尚无一种可接受的治疗方法。药物治疗只能提供暂时的症状缓解，这进一步使得手术治疗成为必要。手术治疗可能始于气管切开术；然而，其结局往往是全喉切除术。从生理角度来看，坏死的软骨是问题的根源。一般外科原则是必须切除无活力的组织以促进愈合。因此，如果切除受影响的喉软骨，喉部应该能够愈合。文献中尚未报道过在保留喉内软组织的情况下完全或近乎完全切除甲状腺软骨和环状软骨。从理论上讲，如果整个软骨框架被切除，气道将失去结构支撑。我们通过动物模型发现，对喉软骨进行黏膜下切除，保留软骨膜和喉内软组织完整，可形成通畅的气道。将展示动物实验和临床经验。
