[Fronto-lateral laryngectomy using a combined endolaryngeal external approach].

Functional laryngectomies-whether subtotal (with significant demolition) or conservative (with limited latero-frontal and frontal demolition)-can, at times, lead to significant post operative functional sequelae. Negative outcomes method proposed calls for an internal, endolaryngeal approach along with an external approach. The internal approach makes it possible to carefully delimit the posterior extension of the laryngeal neoplasm. The external approach, on the other hand, makes it possible to remove the anterior commissure and part of one or both vocal cords in a single unit together with a smaller portion of the thyroid cartilage. In particular, the endolaryngeal approach using suspension microlaryngoscopy makes it possible to section the laryngeal structures all the way up to the internal surface of the thyroid cartilage and, anteriorly, along the midline from the incision to the lower edge of the cartilage. From above the larynx is opened by means of a transfixed section of the thyroid membrane and of the epiglottis at the upper edge of the thyroid cartilage. The ends of the section are joined with the upper ends of the section prepared using the endolaryngeal approach. Cranio-caudal dissection of the internal perichondrium of the thyroid larynx is then performed, from behind, all the way to the endolaryngeal sections and, from below, to the point where the cord ligaments are inserted. The larynx is opened from below by means of a horizontal section in the crico-thyroid membrane at the upper edge of the cricoid cartilage. The trapezoidal section of the lower part of the protruding corner of the thyroid cartilage. After having joined the edges of the crico-thyroid section with the lower edge of the endolaryngeal sections, the entire piece is then removed in a single unit. This method, for treatment of carcinoma of the anterior commissure and of the anterior portion of one or both vocal cords (T1 and T2 N0 M0), must be used after accurate clinical evaluation; it is particularly appropriate for subjects with cordo-commissure carcinoma which was previously treated with radiotherapy. The method meets the requirements of oncological radicalness, permits one to perform both the external and internal sections under visual control and maintains the endolaryngeal diameters nearly intact.