Textbook of Surgery of Larynx and Trachea

Foreword
Preface
Contents
1: Physiology of the Larynx
1.1 Introduction
1.2 Larynx and Breathing (Quietly)
1.2.1 Quiet Spontaneous Breathing
1.2.2 Breath Modulation Maneuvers
1.2.3 Breath-Hold Maneuvers
1.2.4 Effect of Capnia Variations on the Glottal Geometry
1.3 Larynx and Cough
1.4 Larynx and Swallowing
1.4.1 Swallowing and Breathing
1.4.2 Laryngeal Closure During Swallowing
1.5 Larynx and Phonation
1.5.1 Expiratory Airstream
1.5.2 Vocal Folds Apposition and Control of Their Physical Properties
1.5.3 Vibratory Capacity of the Vocal Folds
1.5.3.1 Epithelium
1.5.3.2 Lamina Propria
1.5.3.3 Vocal Muscle
1.5.4 Vocal Fold Vibration
1.5.5 Control of the Fundamental Frequency
1.5.6 Control of Vocal Intensity
1.6 Nervous System Control
1.6.1 Peripheral Nervous System
1.6.1.1 Sensitive Innervation
Sensitive Receptors in the Larynx
The Superior Laryngeal Nerve, the Main Sensory Nerve of the Larynx
1.6.1.2 Motor Innervation
The External Branch of the Superior Laryngeal Nerve
The Inferior Laryngeal Nerve
1.6.1.3 Brain Stem Nuclei
The Nodal Ganglion, the Nucleus of the Solitary Tract
The Nucleus Ambiguus
1.6.2 Central Nervous Control of the Larynx
1.6.2.1 Cortical Centers
1.6.2.2 Breathing
1.6.2.3 Swallowing
Internal Schema
1.6.2.4 Phonation
Audio-Phonatory Control (Feedback Control) and Internal Schema (Feedforward Control)
References
2: Assessment of Voice and Respiratory Function
2.1 Introduction
2.2 Inspection and Auditory Assessment
2.2.1 GRBAS Scale
2.2.2 IINFVo Perceptual Rating Scale
2.2.3 Voice Handicap Index (VHI)
2.3 Examination and Vocal Fold Imaging
2.3.1 Videolaryngostroboscopy
2.3.2 High-Speed Videokymography (SHVK)
2.4 Respiratory Function Assessment in Clinic
2.4.1 Maximum Phonation Time (MPT)
2.4.2 Pulmonary Function Tests: Spirometry
2.5 Other Types of Vocal and Respiratory Function Tests
2.5.1 Phonetogram or Voice Range Profile (VRP)
2.5.2 Subglottic Air Pressure Measurement
2.6 Adjunct Tests for Vocal Assessments
2.6.1 Electromyography
References
3: Anatomy and Microanatomy of the Larynx
3.1 Introduction
3.2 Gross Anatomy
3.2.1 Laryngeal Framework
3.2.2 Innervation
3.3 Microanatomy
3.3.1 Epithelium
3.3.2 Basement Membrane Zone (BMZ)
3.3.3 Lamina Propria
3.3.4 Vocal Fold Muscles
3.4 Physiology and Pathophysiology
3.4.1 Body-Cover Theory
3.4.2 Myoelastic-Aerodynamic Theory
3.4.3 Pathophysiology: Voice Production in a Pathological State
3.5 Selected VF Diseases
3.5.1 Vocal Fold Scars
3.5.2 Reinke’s Edema
3.5.3 Vocal Fold Lesions
References
4: Fundamentals of Laryngeal Surgery: Approaches, Instrumentation, and Basic Microlaryngoscopic Techniques
4.1 Introduction
4.1.1 Basic Techniques for Laryngeal Endoscopy
4.2 Fundamentals of Endolaryngeal Surgery and Equipment
4.3 Laser Systems Used in Laryngeal Endoscopic Surgery
4.4 Robotic Surgery
4.5 Endolaryngeal Versus Extralaryngeal Approach to the Larynx
4.6 Anaesthesia, Perioperative Care, and Adjunctive Medical Therapy
4.7 Office-Based Laryngeal Procedures
4.8 Complications of Endoscopic Laser Surgery
4.9 Tips and Pearls to Avoid Complications
References
5: Microphonosurgery Using Cold Steel
5.1 Introduction
5.2 History of Phonomicrosurgery
5.2.1 Development of Laryngoscopy
5.2.2 Evolution of Phonosurgery
5.2.3 Voice Altering Surgery
5.2.4 Instruments and Devices
5.3 Operating Laryngoscopes
5.3.1 Basic Components
5.3.2 Additional Components
5.3.3 Extended Components
5.3.3.1 Laser
5.3.3.2 Distending
5.3.3.3 Distending with Laser
5.3.3.4 Angled Scopes
5.3.3.5 High-Frequency Jet Ventilation
5.4 Operating Microscopes
5.4.1 Setup
5.4.2 Laser
5.5 Rigid Endoscopes
5.5.1 A Brief History
5.5.2 Specification
5.5.3 Setup
5.5.4 Operating with Endoscopes
5.5.5 Exoscopy
5.6 Instruments
5.6.1 Forceps
5.6.2 Scissors/Blades
5.6.3 Blunt Dissectors/Elevators
5.6.4 Biopsy Forceps
5.6.5 Microdebrider
5.6.6 Monopolar Diathermy
5.7 Principles of Phonomicrosurgery
5.8 Setup for Cold Steel Microlaryngoscopy
5.8.1 Choice of Laryngoscope
5.8.2 Position of the Patient
5.8.3 Introducing the Laryngoscope
5.8.4 Position of the Surgeon
5.8.5 The ‘Difficult’ Laryngoscopy
5.9 Surgery for Various Lesions
5.9.1 Excision of Vocal Fold Polyp
5.9.2 Nodules
5.9.3 Vocal Fold Cyst
5.9.4 Papilloma
5.9.5 Scar, Sulcus and Webbing
5.9.6 Granuloma
5.10 Microscopic Injection Techniques
5.10.1 Augmentation Injection
5.10.2 Botulinum Toxin Injection
5.11 Training in Laryngology
5.11.1 Principles of Training
5.11.2 Laryngeal Models
5.11.3 Simulation Platforms
5.12 Optical Enhancement Techniques
5.12.1 Blue Light Imaging
5.12.2 Fluorescence
References
6: CO2 Laser Surgery for the Larynx
6.1 Introduction
6.2 Basics of Laser Physics
6.3 Laser Flux, Fluence and Irradiance
6.4 Thermal Relaxation and Damage Time
6.5 Continuous Wave vs. Pulsed Wave
6.6 Ultrapulse and Superpulse Modes
6.7 Scanning Technology
6.8 CO2 Laser Effects on Tissue
6.9 Haemostasis
6.10 Histopathological Considerations
6.11 Laser Fibres
6.12 TORS and the CO2 Laser
6.13 Pitfalls and Pearls in CO2 Laryngeal Laser Surgery
6.14 Conclusion
References
7: Thyroplasty/Framework Surgery
7.1 The Medialization Thyroplasty (MT)
7.1.1 The Procedure
References
8: Surgical Management of Vocal Fold Scars
8.1 Introduction
8.2 Vocal Fold Healing
8.3 Biomechanical Consequences of Vocal Fold Scarring
8.4 Etiopathogenesis of Vocal Fold Scars
8.4.1 Iatrogenic Mechanisms
8.4.2 Congenital Theory of Epidermoid Cysts Evolution
8.4.3 Acquired Theory of Sulcus
8.5 Therapeutic Options
8.5.1 General Principles
8.5.2 Treatment Options to Improve Pliability
8.5.3 Treatment Options in Case of Glottic Leakage
References
9: Regenerative Procedures in Laryngology
9.1 What Is Regenerative Medicine? How Can It Be Useful in Laryngology?
9.2 Which Laryngeal Diseases Should Be Addressed?
9.2.1 Vocal Fold Scar
9.2.1.1 Cell Therapy
9.2.1.2 Material-Based Approaches (Scaffolds, Gels, and Polymers)
9.2.1.3 Use of Cytokines and Growth Factors
9.2.1.4 Gene (Modulation) Therapy
9.2.2 Vocal Fold Paresis
9.2.2.1 Cell Therapy
9.2.2.2 Use of Cytokines and Growth Factors
9.2.3 Laryngeal Transplantation/Carcinoma
9.3 Outlook
References
10: Voice Feminization and Masculinization
10.1 Voice Feminization and Masculinization
10.1.1 Introduction
10.1.1.1 Background
10.1.1.2 The Physics of Transgender Voice Alteration
10.1.2 Voice Therapy
10.1.2.1 Pitch Perception and Gender Recognition
10.1.3 Surgery
10.1.3.1 Preoperative Assessment
10.1.3.2 Voice Questionnaires
10.1.3.3 Informed Consent
10.1.4 Voice Feminization
10.1.4.1 Voice Feminization: The Different Procedures
Cricothyroid Approximation (CTA)
Procedure
Cricothyroid Subluxation
Anterior Commissure Advancement
Webbing Procedure (Wendler’s Glottoplasty)
10.1.5 Post-treatment Follow-Up
10.1.6 Conclusion
10.1.7 References
10.2 The Rationale for Feminization Laryngoplasty
10.3 Feminization Laryngoplasty: Technique [23]
10.3.1 Preoperative
10.3.2 Surgery
10.3.3 Postoperative
10.3.4 Caveats and Thoughts
10.3.5 Conclusion
10.3.6 Online Media References
10.3.7 References
10.4 Laser-Assisted Voice Adjustment (LAVA)
10.4.1 Reference
10.4.2 Summary: Voice Feminization
10.5 Voice Masculinization
10.5.1 Voice Masculinization
10.5.1.1 Relaxation Thyroplasty
10.5.1.2 Other Procedures
10.5.1.3 Summary: Voice Masculinization
10.5.2 References
11: Exercise-Induced Laryngeal Obstruction
11.1 Background
11.1.1 Exercise (E) as Inducer (I) for Laryngeal (L) Obstruction (O) (EILO)
11.1.2 Symptoms
11.1.3 Differential Diagnosis
11.1.4 Evaluation
11.1.5 The Continuous Laryngoscopy Exercise (CLE) Test
11.1.6 CLE Test Evaluation
11.1.7 Epidemiology
11.1.8 Etiology Theories
11.1.8.1 EILO at the Supraglottic Level
11.1.8.2 EILO at the Glottic Level
11.2 Treatments
11.2.1 Surgical Treatment
11.2.2 Detailed Description of the Procedure
11.2.3 Effect of Surgical Treatment
11.3 Important Results
11.4 Definition
References
12: Office-Based Procedures
12.1 Introduction
12.2 Possible Interventions in Office-Based Phonosurgery
12.2.1 Biopsy/Excision
12.2.2 Injection
12.2.3 Augmentation
12.2.4 Laser
12.2.5 Arytenoid Mobility Test
12.2.6 EMG
12.2.7 Varia
12.3 Setting
12.3.1 Corona Virus and Protective Measures
12.3.2 Patient Position
12.3.3 One Surgeon or Two Surgeons?
12.3.4 Instrumentation
12.3.5 Combined Methods
12.4 Medication and Anesthesia
12.4.1 Medication
12.4.2 Monitoring
12.4.3 “Verbal” Anesthesia
12.4.4 Intranasal Anesthesia
12.4.5 Intraoral Anesthesia
12.4.6 Anesthesia of the Pharynx and Larynx
12.5 Complications and Failures
12.6 Transoral Surgery
12.6.1 Palpation-Biopsy-Excision
12.6.2 Injection and Augmentation
12.6.3 Laser Surgery
12.7 Transnasal Surgery
12.7.1 Palpation-Biopsy-Excision
12.7.2 Injection and Augmentation Laryngoplasty
12.7.3 Laser Surgery
12.8 Percutaneous Procedures
12.8.1 Injections
12.8.2 Vocal Fold Medialization
12.8.3 Percutaneous Endolaryngeal Laser Surgery
12.8.4 Transnasal Esophagoscopy (TNE)
12.8.5 Transnasal Tracheoscopy (TNT)
12.9 Possible Complications
12.10 Disinfection and Hygiene
12.11 Outlook
References
13: Laryngeal Surgery in Children
13.1 Introduction
13.2 Laryngeal Assessment
13.3 Equipment and Theatre Setup
13.4 Paediatric Anaesthetic Considerations
13.5 Disorders of the Larynx in Children and Their Surgical Management
13.5.1 Laryngomalacia
13.5.1.1 Introduction
13.5.1.2 Clinical Features
13.5.1.3 Diagnosis
13.5.1.4 Management
13.5.1.5 Surgery
13.5.2 Vocal Cord Paralysis
13.5.2.1 Introduction
13.5.2.2 Unilateral Vocal Cord Paralysis
Clinical Features
Diagnosis
Management
Surgery
13.5.2.3 Bilateral VCP
Clinical Features
Diagnosis
Management
Endoscopic Surgery
13.5.3 Subglottic Stenosis
13.5.3.1 Introduction
13.5.3.2 Clinical Features and Diagnosis
13.5.3.3 Surgery
13.5.3.4 Endoscopic
13.5.3.5 Medical
13.5.3.6 Open Surgery
13.5.4 Subglottic Cysts
13.5.4.1 Introduction
13.5.4.2 Clinical Presentation and Diagnosis
13.5.4.3 Surgery
13.5.5 Recurrent Respiratory Papillomatosis
13.5.5.1 Introduction
13.5.5.2 Natural History
13.5.5.3 Clinical Features
13.5.5.4 Diagnosis
13.5.5.5 Surgery
13.5.5.6 Adjuvant Therapy
13.5.6 Vocal Cord Nodules
13.5.6.1 Introduction
13.5.6.2 Clinical Features and Diagnosis
13.5.6.3 Management
13.5.6.4 Surgery
13.5.7 Anterior Glottic Web
13.5.7.1 Introduction
13.5.7.2 Clinical Features
13.5.7.3 Diagnosis
13.5.7.4 Management
13.5.7.5 Surgery
13.5.8 Laryngeal Cleft
13.5.8.1 Introduction
13.5.8.2 Clinical Features
13.5.8.3 Diagnosis
13.5.8.4 Medical Management
13.5.8.5 Surgery
13.5.8.6 Endoscopic
13.5.8.7 Open
13.5.9 Subglottic Haemangioma
13.5.9.1 Introduction
13.5.9.2 Clinical Features
13.5.9.3 Diagnosis
13.5.9.4 Management
13.5.9.5 Medical Treatment
13.5.9.6 Surgery
13.5.10 Vallecular Cysts
13.5.10.1 Introduction
13.5.10.2 Clinical Presentation
13.5.10.3 Diagnosis
13.5.10.4 Surgery
13.5.11 Laryngeal Manifestations of Systemic Diseases
13.5.11.1 Laryngeal Sarcoidosis
Surgery
13.5.11.2 Granulomatosis with Polyangiitis of the Larynx
Surgery
13.5.11.3 Neurofibromas of the Larynx
Surgery
References
14: Recurrent Respiratory Papillomatosis
14.1 Introduction
14.2 Epidemiology
14.3 Human Papillomavirus
14.4 Immune Response
14.5 Etiology
14.6 Clinical Presentation
14.7 Diagnosis
14.8 Clinical Course
14.9 Quality of Life
14.10 Staging
14.11 Disease Severity
14.12 Surgery
14.13 Adjuvant Treatment
14.14 Speech Therapy
14.15 Conclusion
References
15: Laryngotracheal Blunt Trauma
15.1 Injury of the Cartilage Framework of the Larynx and Cervical Trachea
15.2 Injury of the Cricoarytenoid Joint
15.3 Laryngeal Soft Tissue Injury
15.4 Emergency Management of Laryngotracheal Blunt Trauma
15.5 Evaluation of Laryngotracheal Injury
15.5.1 Laryngotracheal Trauma Repair
15.6 Postoperative Management
15.7 Tips and Pearls
References
16: Glottic Airway Stenosis
16.1 Introduction
16.2 Anatomy of the Glottis
16.3 Relevant Embryology
16.4 Physiology of the Glottis
16.5 Clinical Assessment
16.6 Anaesthesia for Glottic Airway Surgery
16.7 Causes of Glottic Stenosis
16.7.1 Congenital Glottic Stenosis
16.7.2 Acquired Causes of Bilateral Impaired Vocal Fold Function
16.7.3 Systemic Causes of Glottic Stenosis
16.7.4 Traumatic Causes of Glottic Stenosis
16.7.5 Infective Causes of Glottic Stenosis
16.7.6 Neoplastic Causes of Glottic Stenosis
16.8 Management of Glottic Stenosis
16.8.1 Laser Techniques
16.8.2 Suture Lateralisation
16.8.3 Selective Reinnervation
16.8.4 Laryngeal Pacing
References
17: Subglottic and Tracheal Stenosis
17.1 Introduction
17.2 Anatomy (Fig. 17.1)
17.3 Etiologies
17.3.1 Children
17.3.1.1 Subglottis
Congenital SGS (Fig. 17.2)
Glottic Webs and Atresia (Fig. 17.3)
Acquired Glotto-SGS (Fig. 17.4)
17.3.1.2 Trachea
17.3.2 Adults
17.3.2.1 Subglottis
17.3.2.2 Trachea
17.4 Preoperative Evaluation
17.4.1 Grading Systems
17.4.1.1 SGS
17.4.2 Basic Assessment
17.4.2.1 History
17.4.2.2 Assessment of General Condition and Preoperative Preparation
17.4.2.3 Radiological Evaluation
17.4.3 Endoscopic Workup
17.4.3.1 Awake Trans-nasal Flexible Laryngoscopy (TNFL)
17.4.3.2 Asleep TNFL (Fig. 17.12)
17.4.3.3 Direct Laryngotracheoscopy with a Bare 0° Rod-Lens Telescope
17.4.3.4 Broncho-Esophagoscopy
17.4.4 Multidisciplinary Teams
17.5 Treatment Options and Techniques
17.5.1 Primary Endoscopic
17.5.2 Open Airway Surgery: General Intraoperative Considerations (See Fig. 17.16)
17.5.3 Laryngotracheal Reconstruction (LTR) with Cartilage Expansion
17.5.3.1 Procedure (Figs. 17.17 and 17.18)
17.5.4 Partial Cricotracheal Resection (PCTR)
17.5.4.1 Procedure (Fig. 17.20)
17.5.5 EPCTR for SGS Combined with Glottic Pathology (Figs. 17.21 and 17.22)
17.5.6 Tracheal Resection with End-to-End Anastomosis
17.5.6.1 Procedure
17.5.7 Slide Tracheoplasty
17.5.7.1 Procedure (Fig. 17.23)
17.5.8 Tension-Releasing Maneuvers in Extensive Airway Resection
17.5.9 Tracheostomy
17.5.9.1 Recommended Sites of Performing the Tracheostomy (Fig. 17.24)
17.6 Postoperative Care and Follow-Up in Open Airway Surgery
17.7 Results
17.7.1 Pediatric LTR and PCTR and Slide Tracheoplasty
17.7.1.1 LTR
17.7.1.2 PCTR and TR
17.7.2 Adult PCTR, LT, and TR
17.7.2.1 PCTR
17.7.2.2 LTR
17.7.2.3 TR
17.8 LTS and COVID-19 Pandemic (Fig. 17.25)
17.9 Tips and Pearls to Avoid Complications
17.10 Future Developments
References
18: Tracheotomy
18.1 Introduction
18.2 Indications for Tracheotomy
18.3 Decision Making for Open Neck Tracheotomy Versus Percutaneous Tracheotomy
18.4 Tracheotomy Techniques
18.4.1 Conventional or Open Neck Tracheotomy
18.4.2 Percutaneous Dilatation Tracheotomy
18.4.3 Tracheotomy in the Pediatric Age Group
18.4.4 Bedside Open Tracheotomy
18.4.5 Emergency Tracheotomy
18.4.5.1 Open Tracheotomy
18.4.5.2 Cricothyroidotomy
18.4.6 Mediastinal Tracheostomy (MT)
18.4.6.1 The Procedure
18.4.6.2 Technical Comments
18.5 Complications of Tracheotomy
18.6 Pearls and Tips
18.6.1 Pearls
18.6.2 Practical Tips
References
19: Neurolaryngology
19.1 Introduction
19.2 Electromyography
19.2.1 Definition
19.2.2 Technique
19.2.3 Other Techniques
19.2.4 New Techniques and Tools
19.2.5 Electrostimulation to Select Cases for Laryngeal Pacing
19.3 Clinical Significance
19.3.1 Diagnosis
19.3.2 Prognosis
19.3.3 LEMG-Guided Injections
19.3.4 Laryngeal Pacing
19.4 Neurolaryngological Disorders
19.4.1 Vocal Cord Paralysis of the Lower Motor Neuron Type: Recurrent and Vagal Nerve Lesions
19.4.2 Vocal Cord Paralysis of the Upper Motor Neuron Type
19.4.3 Laryngeal Dystonia: Adductor and Abductor Spasmodic Dysphonia
19.4.4 Stroke
19.4.5 Essential Voice Tremor
19.4.6 Parkinson’s Disease
19.4.7 Other Central Nervous System Diseases
19.5 Botulinum Toxin Treatment in the Larynx
References
20: Spasmodic Dysphonia
20.1 Introduction
20.2 Treatment Options for AdSD
20.2.1 Nonsurgical Treatment
20.2.1.1 Botulinum Toxin: The Current Gold Standard of Therapy
20.2.1.2 Oral Medication
20.2.1.3 Voice Therapy
20.2.2 Surgical Treatment
20.2.2.1 Selective Laryngeal Adductor Denervation–Reinnervation (SLAD-R)
20.2.2.2 Thyroplasty Type II (TP II)
20.2.2.3 Endoscopic Laser Thyroarytenoid Myoneurectomy (TA Myoneurectomy)
20.2.2.4 Anecdotal/Experimental Therapies
20.3 AbSD Treatment
20.4 Concluding Remarks
20.5 Recommendations for the Future
References
21: Nerve Reconstruction
21.1 Introduction
21.2 Anatomical Landmarks and Prerequisites
21.3 Nonselective Reinnervation (in Unilateral Nerve Lesion)
21.3.1 Acute Lesion of the Laryngeal Nerves
21.3.2 Reinnervation of Chronic Unilateral Vocal Cord Paralysis
21.3.2.1 Inferior Laryngeal Nerve Lesion (Recurrent Nerve Paralysis)
General Indications
Surgical Technique (Including Specific Recommendations)
The Ansa Cervicalis to RLN Anastomosis (“Ansa Technique”) Fig. 21.1
Technical Variations
The Nerve-Muscle Pedicle Implantation of HM Tucker
Combinations
21.3.2.2 Superior Laryngeal Nerve Lesions
External Branch (or Cricoid Branch) of the Superior Laryngeal Nerve Lesions
Internal Branch of the SLN Lesions
21.3.2.3 Vagus Nerve Lesion
21.4 Selective Motor Reinnervation (in Bilateral Nerve Lesion)
21.4.1 Surgical Techniques
21.4.1.1 Nerve-Muscle Pedicle with the Ansa Hypoglossi
Technique
Results
21.4.1.2 Selective Reinnervation Using the Phrenic Nerve
Technique (Fig. 21.3a)
Nerve Identification
Results
21.5 Other Techniques or Indication of Nerve Reconstruction
21.5.1 Laryngeal Denervation-Reinnervation in Laryngeal Dystonia
21.5.2 Laryngeal Pacing and Combination
21.6 The Future of Nerve Reconstruction
21.7 Conclusion
References
22: Preoperative Assessment of Laryngeal Cancer
22.1 Epidemiology of Laryngeal Cancer
22.2 Staging
22.3 Imaging
References
23: HPV and Laryngeal Cancer
23.1 p16 Immunohistochemistry as Surrogate Marker
23.2 HPV Prevalence and Prognostic Value
23.3 Serologic Testing
References
Untitled
24: Transoral Approach for Early Laryngeal Cancers
24.1 Introduction
24.2 Preoperative Diagnostic Procedures
24.3 Surgical Technique
24.3.1 Classification of Procedures for Glottic Carcinoma
24.3.1.1 Subepithelial Cordectomy (Type I)
24.3.1.2 Subligamental Cordectomy (Type II)
24.3.1.3 Transmuscular Cordectomy (Type III)
24.3.1.4 Total or Complete Cordectomy (Type IV)
24.3.1.5 Extended Cordectomy Encompassing the Contralateral Vocal Fold (Type Va)
24.3.1.6 Extended Cordectomy Encompassing the Arytenoid (Type Vb)
24.3.1.7 Extended Cordectomy Encompassing the Ventricular Fold (Type Vc)
24.3.1.8 Extended Cordectomy Encompassing the Subglottis (Type Vd)
24.3.1.9 Extended Cordectomy for Cancers Arising from the Anterior Commissure (Type VI)
24.3.2 Classification of Procedures for Supraglottic Carcinoma
24.3.2.1 Limited Excision (Type I)
24.3.2.2 Medial Supraglottic Laryngectomy with Partial Resection of the Preepiglottic Space (Type II)
24.3.2.3 Medial Supraglottic Laryngectomy with Resection of the Preepiglottic Space (Type III)
24.3.2.4 Lateral Supraglottic Laryngectomy (Type IV)
24.4 Recurrence: Follow-Up, Diagnosis, and Management
24.5 Oncological Outcomes
24.5.1 Glottic Cancer
24.5.2 Supraglottic Cancer
24.5.3 Transoral Laser Microsurgery Excision Margins
24.5.4 Anterior Commissure Involvement and Vocal Fold Mobility Impairment
24.6 Functional Outcomes
24.7 Conclusions
References
25: Transoral Approach for Extended Cancers (T3–T4a)
25.1 Introduction
25.2 Indications
25.3 Exposure and Resection
25.4 Surgical Margins
25.5 Oncologic Outcomes
25.6 Complications
25.7 Functional Outcomes
References
26: Open Neck Approaches: Partial and Reconstructive Laryngectomies
26.1 Introduction
26.2 The Preoperative Workup
26.2.1 Direct Pharyngolaryngoscopy
26.2.2 Imaging
26.3 Partial Surgery for Laryngeal Cancer
26.3.1 Cordectomy
26.3.1.1 Core Messages
26.3.1.2 Indications
26.3.1.3 Surgical Technique
26.3.1.4 Results
26.3.1.5 Tips and Pearl to Avoid Complications
26.3.2 Frontolateral Vertical Laryngectomy
26.3.2.1 Core Message
26.3.2.2 Indications
26.3.2.3 Surgical Technique
26.3.2.4 Specific Recommendations According to the Technique
26.3.2.5 Results
26.3.2.6 Tips and Pearl to Avoid Complications
26.3.3 Frontal Anterior Laryngectomy with Epiglottoplasty
26.3.3.1 Core Message
26.3.3.2 Indications
26.3.3.3 Surgical Technique
26.3.3.4 Specific Recommendations According to the Technique
26.3.3.5 Recommendations for Follow-up
26.3.3.6 Results
26.3.3.7 Tips and Pearl to Avoid Complications
26.3.4 Open Partial Horizontal Laryngectomies (OPHLs)
26.3.4.1 Supraglottic Laryngectomy
26.3.4.2 Supracricoid Laryngectomy with CHEP
26.3.4.3 Supracricoid Laryngectomy with CHP
26.3.4.4 Supratracheal Partial Laryngectomy with Tracheo
26.3.4.5 Specific Recommendations
26.3.4.6 Results
26.3.4.7 Recommendations for Follow-Up
26.3.4.8 Tips and Pearl to Avoid Complications
26.3.5 Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy (CHEP): OPHL Type IIa
26.3.5.1 Core Message
26.3.5.2 Indications
26.3.5.3 Surgical Technique
26.3.5.4 Specific Recommendations According to the Technique
26.3.5.5 Recommendations for Follow-up
26.3.5.6 Results
26.3.5.7 Tips and Pearl to Avoid Complications
26.3.6 Supracricoid Partial Laryngectomy with Cricohyoidopexy (CHP): OPHL Type IIb
26.3.6.1 Core Message
26.3.6.2 Indication
26.3.6.3 Surgical Technique
26.3.6.4 Specific Recommendations
26.3.6.5 Results
26.3.6.6 Recommendations for Follow-Up
26.3.6.7 Tips and Pearl to Avoid Complications
26.3.7 Supratracheal Partial Laryngectomy with Tracheohyoidoepiglottopexy (THEP) and Tracheohyoidopexy (THP): OPHL Type III
26.3.7.1 Core Message
26.3.7.2 Indication
26.3.7.3 Surgical Technique
26.3.7.4 Specific Recommendations
26.3.7.5 Results
26.3.7.6 Recommendations for Follow-Up
26.3.7.7 Tips and Pearl to Avoid Complications
26.4 Partial Surgery for Hypopharyngeal Cancer
26.4.1 Posterior Partial Pharyngectomy
26.4.1.1 Core Messages
26.4.1.2 Indications
26.4.1.3 Specific Assessment
26.4.1.4 Surgical Technique
26.4.2 Partial Lateral Pharyngectomy (Trotter)
26.4.3 Supracricoid Hemipharyngolaryngectomy
26.4.3.1 Core Messages
26.4.3.2 Indications
26.4.3.3 Surgical Technique
26.4.3.4 Recommendations for Follow-up
26.4.3.5 Results
26.4.3.6 Tips and Pearl to Avoid Complications
26.4.4 Supraglottic Hemipharyngolaryngectomy
26.4.4.1 Core Message
26.4.4.2 Indications
26.4.4.3 Surgical Technique
26.4.4.4 Recommendations for Follow-up
26.4.4.5 Results
26.4.4.6 Tips and Pearl to Avoid Complications
References
Total Laryngectomy
27.1 Selected Details of Larynx Anatomy
27.1.1 Lymphatic Network
27.1.1.1 Glottis
27.1.1.2 Supraglottis
27.1.1.3 Subglottis
27.1.2 Vessels Supply
27.1.3 Nerves Supply
27.1.4 Surrounding Structures Important for Surgical Anatomy
27.1.5 Directions of Extralaryngeal Spread
27.1.5.1 Supraglottis
27.1.5.2 Glottis
27.1.5.3 Subglottis
27.1.6 Pattern of Metastasis
27.2 General Principles of Surgical and Combined Treatment in the Advanced Stages of Disease
27.3 Total Laryngectomy
27.3.1 History
27.3.2 Indications and Contraindications
27.3.2.1 Common Indications
27.3.2.2 Rare Indications
27.3.2.3 Contraindications
27.3.2.4 Nonresectable Disease
27.3.3 Technique
27.3.4 Salvage Total Laryngectomy after Conservation Laryngeal Surgery (TOLM, Open Partial Laryngectomy OPL)
27.3.5 Salvage Total Laryngectomy after RT or RT/CT Failure
27.3.6 The Indications to Plan a Reconstruction After TL Can Be Divided into
27.3.6.1 The Flap Techniques Used in Closure of the Defect
27.3.6.2 Other Surgical Tips
27.3.7 Cost-Effectiveness
27.3.8 The Transoral Endoscopic Ultrasonic Total Laryngectomy (TOUSS-TL)
27.3.9 Transoral Robotic Total Laryngectomy (TORS)
27.3.10 Postoperative Complications
27.4 Swallowing Rehabilitation After Total Laryngectomy
27.5 Speech Rehabilitation After Total Laryngectomy
27.6 General Care After Total Laryngectomy
27.7 Prognosis
27.8 Neck Dissection
27.9 Treatment Failures
27.10 Health-Related Quality of Life Following Total Laryngectomy
27.11 Long-Term Follow-Up
27.12 Summary
References
28: Principles of Salvage Laryngeal Surgery
28.1 Introduction
28.2 Evaluation of Recurrence
28.3 Patient Selection
28.4 Setting
28.5 Perioperative Optimization and Planning
28.5.1 The Use of Antibiotics
28.6 Surgical Management
28.6.1 Surgical Principles
28.6.2 Neck Management
28.6.3 The Use of Flaps
28.6.4 Management of the Thyroid Gland
28.6.5 The Use of Salivary Bypass Tubes
28.6.6 Voice Rehabilitation
28.7 Complications
28.8 Postoperative Management
28.8.1 Postoperative Care
28.8.2 Swallowing
28.9 Conclusions
References
29: Management of Tracheal Tumors
29.1 Introduction
29.2 Epidemiology
29.3 Etiology
29.4 Anatomy
29.5 Histopathological Tumor Types
29.6 Clinical Presentation
29.7 Evaluation and Diagnosis
29.8 Setting
29.9 Management
29.10 Surgery
29.11 Transoral and Endotracheal Debridement
29.12 Endotracheal Stenting
29.13 Radiotherapy
29.14 Chemotherapy
29.15 Immunotherapy
29.16 Conclusion
References
30: Reconstruction of the Laryngeal and Pharyngeal Defects
30.1 Introduction
30.2 Classification of Laryngopharyngeal Defects
30.3 Type I Laryngeal Defect (Vertical Hemilaryngectomy)
30.4 Type II Laryngeal Defect (Simple Total Laryngectomy)
30.5 Type Ia Hypopharyngeal Defect (Defect in the Hypopharyngeal Posterior Wall)
30.6 Type Ib Hypopharyngeal Defect (Defect in the Hypopharyngeal Lateral Wall)
30.7 Type II Hypopharyngeal Defects (Total Laryngectomy with Partial Pharyngectomy)
30.7.1 Regional Flaps
30.7.1.1 Pectoralis Major Myocutaneous Flap
30.7.1.2 Supraclavicular Flap
30.7.2 Free Flaps
30.7.2.1 Radial Forearm Free Flap
30.7.2.2 Anterolateral Thigh Free Flap
30.8 Type III Hypopharyngeal Defect (Total Laryngectomy with Total Pharyngectomy)
30.8.1 Regional Flaps
30.8.1.1 Pectoralis Major Myocutaneous Flap
30.8.2 Free Flaps
30.8.2.1 Radial Forearm Free Flap
30.8.2.2 Anterolateral Thigh Free Flap
30.8.2.3 Jejunal Free Flap
30.8.2.4 Gastro-Omental Free Flap
30.9 Type IV Hypopharyngeal Defect (Laryngo-Pharyngo-Esophagectomy)
30.10 Salivary Bypass Tubes
References
31: Surgery of Larynx and Trachea: Voice Restoration and Total Laryngectomy
31.1 Historical Development of Voice Restoration
31.2 Technical and Physiological Aspects of Voice Restoration with Voice Prostheses
31.3 Surgical Procedures Required for Successful Utilization of a Voice Prosthesis
31.4 Management of Voice Prostheses and Their Complications
31.5 Changing a Voice Prosthesis
31.6 Speaking Problems with a Voice Prosthesis
31.7 Gastroesophageal Reflux
31.8 HMEs and Tracheostomy Valves
31.9 Alternatives to Voice Prostheses
References
32: Da Vinci Robotic Surgery for Laryngeal Cancers
32.1 Introduction
32.2 The da Vinci Robotic Surgical System
32.3 TORS Versus Microsuspension Laryngoscopy
32.4 Single Port “SP” da Vinci System
32.5 Clinical Applications
32.6 TORS Supraglottic Laryngectomy
32.7 TORS Glottic Cordectomy
32.8 TORS Hypopharyngectomy
32.9 TORS Total Laryngectomy
32.10 Conclusions
References
33: Robotic Surgery: FLEX System
33.1 Retractors
33.2 Instruments
33.3 Applications I: Benign Lesions
33.4 Applications II: Malignant Tumors
33.5 Conclusion and Outlook
References
34: Surgery for Swallowing Disorders
34.1 Introduction
34.2 Evaluation of Dysphagia
34.3 Management of Dysphagia
34.3.1 Aspiration
34.3.2 Cricopharyngeus Muscle Dysfunction (CPMD)
34.3.3 Gastroesophageal Reflux Disease (GERD)
34.3.4 Obstructive Esophageal Pathology
34.3.5 Diverticular Diseases
34.3.6 Motility Disorders
34.4 Multiple Choice Questions
References
35: Preoperative and Postoperative Speech Therapy
35.1 Place of the Speech Language Therapist in the care pathway
35.1.1 Voice and Swallowing Assessment as a Starting Point for Patient’s Management
35.1.1.1 Voice and Speech Assessment
Interviewing the Patient, Self-Evaluation Questionnaires/Scales
Quantitative Subjective Perceptual Assessment
Acoustic Parameters for Objective Measures
Laryngeal Imaging: Examining Laryngeal Anatomy and Function
35.1.1.2 Swallowing Assessment
Interview and Self-Evaluation Questionnaires and Scales
Swallowing Imaging: Examining Pharyngo-Laryngeal Anatomy and Function
35.1.2 General Goals of the SLT
35.1.2.1 Indirect Therapy, Holistic and Behavioral
35.1.2.2 Direct Therapy, Organic and Functional
35.1.2.3 Global Management
35.1.2.4 SLT’s Role According to the Specificities of the Pathologies
35.2 Benign Pathologies of the Larynx with Surgery Limited to the Glottis
35.2.1 Exudative Lesions of Reinke’s Space, Phonotraumatic Vocal Hyperfunction
35.2.2 Cyst, Sulcus, Scar
35.2.3 Unilateral Vocal Fold Immobility
35.3 Laryngeal Cancer and General Principles for SLTs
35.3.1 Collaboration for a Better Quality of Life
35.3.2 Cancer Disease and Life Plans
35.3.3 Caregiver Involvement
35.3.4 Associated Treatments
35.4 Voice, Speech, and Swallowing Assessment in the Context of Laryngeal Cancer
35.4.1 Voice and Speech Assessment and Management
35.4.1.1 Perceptual and Self-Evaluation of Voice
35.4.1.2 Acoustic Evaluation
35.4.1.3 Laryngeal Imaging
35.4.1.4 The SLT’s Treatment Plan
Direct Therapy
Indirect Therapy
35.4.2 Swallowing Assessment and Management
35.4.2.1 The Organic and Functional Assessment
35.4.2.2 The SLT’s Treatment Plan
Direct Therapy
Indirect Therapy
35.5 SLT Specific Management for Endoscopic or External Laryngeal Surgery
35.5.1 Transoral Surgery
35.5.1.1 Glottic Carcinoma
SLT Goals
Timing
Vocal Results
35.5.1.2 Supraglottic Carcinoma
Voice Rehabilitation
Swallowing Rehabilitation
35.5.2 External Surgery
35.5.2.1 Glottic Carcinoma
Vertical Partial Laryngectomy
SLT’s Goal
Vocal Results
Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy (CHEP)
SLT’s Goal
Vocal Results
Swallowing Results
35.5.2.2 Supraglottic Carcinoma
Supraglottic Laryngectomy
SLT’s Goal
Supracricoid Partial Laryngectomy with Cricohyoidopexy (CHP)
SLT’s Goal
35.6 Conclusions
References