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‘Flaccid neoglottis’ following supracricoid partial laryngectomy: laryngoscopic revision assisted by navigation system

Published online by Cambridge University Press:  05 September 2011

M Nakayama ,
Y Seino ,
M Okamoto  and
T Matsuki
M Nakayama*
Affiliation:
Department of Otorhinolaryngology, Kitasato University School of Medicine, Kanagawa, Japan
Y Seino
Affiliation:
Department of Otorhinolaryngology, Kitasato University School of Medicine, Kanagawa, Japan
M Okamoto
Affiliation:
Department of Otorhinolaryngology, Kitasato University School of Medicine, Kanagawa, Japan
T Matsuki
Affiliation:
Department of Otorhinolaryngology, Kitasato University School of Medicine, Kanagawa, Japan
*
Address for correspondence: Dr Meijin Nakayama, Department of Otorhinolaryngology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 252-0374, Japan Fax: +81 42 778 8441 E-mail: meijin@med.kitasato-u.ac.jp
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Abstract

Objective:

Supracricoid partial laryngectomy is a reliable laryngeal preservation procedure for tumour stage 2 and selected stage 3 to 4 laryngeal cancers. Of 70 patients thus treated, two (3 per cent) had ‘flaccid neoglottis’, i.e. redundant mucosa at the inner arytenoid edge which intermittently obstructed the neoglottis. We discuss the mechanism and management of this complication.

Method:

The two cases are presented. A navigation system was used to assist surgery. Neoglottal spatial alteration (specifically cross-sectional area) was assessed pre- and post-operatively using three-dimensional computed tomography. Voice was also evaluated.

Results:

Inspiratory stridor and delayed stomal closure were the main symptoms. Minimum neoglottal cross-sectional area was smaller in case one than in non-affected patients. Both patients had relatively rougher and breathier voices, but had adapted well to this.

Conclusion:

Flaccid neoglottis is mainly due to excessive anterior retraction of residual laryngeal mucosa and to excessive mucosal pliability with age. A navigation system was useful for confirmation, but the potential for incorrect image recognition should be kept in mind. Flaccid neoglottis was treatable, with improved laryngeal function.

Keywords

Laryngeal NeoplasmsCarcinomaLaryngectomy
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 12 , December 2011 , pp. 1315 - 1319
Copyright
Copyright © JLO (1984) Limited 2011

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