[Partial laryngectomies with difficult presentations. Apropos of the surgical treatment of laryngeal epithelial tumors].

Difficult indications for certain partial laryngectomies are presented. Anatomically, the difficulties stem from the thyroid cartilage and paraglottic space in which invasion (difficult to determine), is contradictory for partial surgery. The principal objective is the cure of the laryngeal cancer all in maintaining laryngeal function. The surgeon must conserve a "minimal arytenoid unit" (the whole formed by the pharyngo-epiglottic fold, the ary-epiglottic fold, the arytenoid and the corresponding cord). Other difficulties not carcinologic are found: physical conditions, social and professional situation, and preexisting local problems (associated laryngocele or previous vocal palsy). Finally, carcinologic difficulties can be seen: the situation of the tumor, the rapidity of its evolution, anatomopathological types, presence of nodes and metastasis and previous physio and chemotherapy.