Near-total laryngectomy with myo-mucosal valved neoglottis.

The entire larynx is usually sacrificed in the process of surgical treatment of T3 glottic carcinoma, trans-glottic carcinoma and pyriform sinus carcinoma, with consequent loss of speech. Most of the uninvolved, cancer-free part of the larynx is discarded for no good reason. According to the surgical principles of oncology, a tumour should be removed with clear margins, but this does not necessarily mean that the whole organ has to be extirpated. In a recently applied surgical procedure, the small tumour-free part of the larynx is fashioned into an innervated myo-mucosal valved shunt joining trachea and pharynx. This neoglottis allows expiration into the pharynx in speech production but it also contracts during swallowing to avoid aspiration. The first four consecutive cases in which this procedure has been carried out with complete success are presented.