Vertical Partial Laryngectomy Hemilaryngectomy

• Indications: select Tj—T2 glottic carcinomas; tumor does not extend beyond V3 of opposite cord; <10 mm of anterior subglottic extension, or <5 mm of posterior subglottic extension; no posterior commissure, cricoarytenoid joint, aryepiglottic fold, posterior surface of the arytenoid, or paraglottic space involvement, good pulmonary function tests (forced expiratory volume [FEVJ >50—60%), patient must also give consent for possible total laryngectomy

• Technique: removes one vocal fold from anterior commissure to vocal process (1//2 of the opposite vocal fold may be removed), ipsilateral false cord, ventricle, paraglottic space, and overlying thyroid cartilage (3 mm posterior strip of cartilage preserved)

• Advantages: allows decannulation, functional glottic voice

• Disadvantages: risk of aspiration, requires initial tracheotomy

• Radiation Salvage: surgery possible for select small original primaries in which the recurrent cancer correlates with the original primary lesion

• Extended Hemilaryngectomy: select T3 lesions or arytenoid involvement; removes one vocal fold, arytenoid, and overlying thyroid cartilage (3 mm posterior strip of cartilage preserved)

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