• Rationale for Procedure: goal is to achieve decannulation and good swallowing and voice function with comparable local control and survival rates versus a total laryngectomy
• Indications: select T2_4 glottic and supraglottic cancers that may involve the pre-epiglottic space, paraglottic space, ventricle, limited thyroid cartilage, or epiglottis; good pulmonary function tests (forced expiratory volume [FEVJ >50—60%); patient must also give consent for possible total laryngectomy
• Contraindications: arytenoid fixation; infraglottic extent of tumor reaching upper border of cricoid cartilage; major pre-epiglottic involvement; invasion of the cricoid cartilage, perichondrium of thyroid cartilage, hyoid bone, posterior arytenoid mucosa; extralaryngeal involvement; or poor pulmonary function
• Technique: remove entire thyroid cartilage bilateral true and false vocal folds, one arytenoid (may spare both arytenoids if not involved), and paraglottic space; spares cricoid cartilage, hyoid bone, and at least one arytenoid cartilage (for speech and swallowing); may reconstruct with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) if epiglottis is spared
• Advantages: allows decannulation, functional glottic voice
• Disadvantages: risk of aspiration, requires initial tracheotomy, dysphonia
• Radiation Salvage: surgery possible for select small original primaries in which the recurrent cancer correlates with the original primary lesion
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