Rovó László, Bach Ádám, Sztanó Balázs, Matievics Vera, Szegesdi Ilona, Castellanos Paul F
Department of Otorhinolaryngology and Head-Neck Surgery, Faculty of Medicine, University of Szeged, Hungary.
Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Hungary.
Laryngoscope. 2017 May;127(5):1109-1115. doi: 10.1002/lary.26142. Epub 2016 Jul 1.
The complex laryngeal functions are fundamentally defined by the cricoid cartilage. Thus, lesions requiring subtotal or total resection of the cricoid cartilage commonly warrant total laryngectomy. However, from an oncological perspective, the resection of the cricoid cartilage would be an optimal solution in these cases. The poor functional results of the few reported cases of total and subtotal cricoidectomy with different reconstruction techniques confirm the need for new approaches to reconstruct the infrastructure of the larynx post cricoidectomy.
Retrospective case series review.
Four consecutive patients with low-grade chondrosarcoma were treated by cricoidectomy with rotational thyrotracheopexy reconstruction to enable the functional creation of a complete cartilaginous ring that can substitute the functions of the cricoid cartilage. The glottic structures were stabilized with endoscopic arytenoid abduction lateropexy. Patients were evaluated with objective and subjective function tests.
Tumor-free margins were proven; patients were successfully decannulated within 3 weeks. Voice outcomes were adequate for social conversation in all cases. Oral feeding was possible in three patients.
Total and subtotal cricoidectomy can be a surgical option to avoid total laryngectomy in cases of large chondrosarcomas destroying the cricoid cartilage. The thyrotracheopexy rotational advancement technique enables the effective reconstruction of the structural deficit of the resected cricoid cartilage in cases of total and subtotal cricoidectomy. An adequate airway for breathing, swallowing, and voice production can be reconstructed with good oncological control. In cases where the pharynx is not involved, good swallowing function can also be achieved.
环状软骨从根本上决定了复杂的喉部功能。因此，需要次全或全切除环状软骨的病变通常需要行全喉切除术。然而，从肿瘤学角度来看，切除环状软骨在这些病例中可能是最佳解决方案。少数报道的采用不同重建技术的全环状软骨切除术和次全环状软骨切除术功能结果不佳，这证实了需要新的方法来重建环状软骨切除术后喉部的结构基础。
回顾性病例系列研究。
连续4例低度软骨肉瘤患者接受环状软骨切除术，并采用旋转式甲状腺气管固定术重建，以功能性地构建一个完整的软骨环，替代环状软骨的功能。通过内镜下杓状软骨外展侧固定术稳定声门结构。对患者进行客观和主观功能测试评估。
证实切缘无肿瘤；患者在3周内成功拔管。所有病例的语音结果足以进行社交交谈。3例患者能够经口进食。
对于破坏环状软骨的大型软骨肉瘤病例，全环状软骨切除术和次全环状软骨切除术可以作为避免全喉切除术的手术选择。甲状腺气管固定术旋转推进技术能够有效重建全环状软骨切除术和次全环状软骨切除术中切除的环状软骨的结构缺损。可以重建足够的气道用于呼吸、吞咽和发声，同时实现良好的肿瘤学控制。在咽部未受累的病例中，也可以实现良好的吞咽功能。
4。《喉镜》，2017年，第127卷，第1109 - 1115页。
