A patient presents with Ca larynx involving left false cord, left arytenoid and left aryepiglottic fold with bilateral mobile true cords. The treatment of choice in this patient is which of the following?
Ans. is 'b' i.e., Horizontal partial hemilaryngectomy * First see parts of Larynx* Larynx is divided into three anatomical sites:-A) Supraglottis# Part of larynx above the vocal cords.# It is further subdivided into two parts.1) Upper supraglottis or epipharynx: - Subsites ofepipharynx are: -i) Suprahyoid epiglottis (tip, lingual and laryngeal surface)ii) Aryepiglotic fold (only laryngeal aspect)iii) Arytenoid2) Lower supraglottisIts subsites are:-i) Infrahyoid epiglottisii) Ventricular bands (vestibular folds or false vocal cords)B) Glottis# It is the part at the level of vocal cords and its subsites are : -i) Vocal cords (True vocal cords)ii) Anterior commisureiii) Posterior commisureC) Subglottis# Below the vocal cords up to lower border of cricoid cartilage.Coming to question* Involvement of unilateral false cord, aryepiglottic folds and arytenoids with mobile cord suggests supraglottic cancer in T2 stage (more than one subsites of supraglottis are involved).TNM classification of supraglottic cancer larynx(American Joint Committee on Cancer, 2002)T1Tumour limited to one subsite of supraglottis with normal vocal cord mobility.T2Tumour invades mucosa of more than one adjacent subsite of supraglottis or glottis or region outside the supraglottis (e.g., mucosa of base of tongue, vallecula, medial wall of pyriform sinus) without fixation of the larynxT3Tumour limited to larynx with vocal cord fixation and or invades any of the following: postcricoid area, pre-epiglottic tissues, paraglottic space and/or minor thyroid cartilage invasionT4aTumour invades through the thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck including deep extrinsic muscle of tongue, strap muscles, thyroid or oesophagus)T4bTumour invades prevertebral space, encases carotid artery or invades mediastinal structures* For T2 stage voice conservative surgery should be done. Supraglottis is excised by partial horizontal laryngectomy.Option 'a & b' need to be explained* Vertical hemilaryngectomy means excision of one half of the larynx on one side, i.e., vertical half is removed which include vertical half of supraglottis, glottis and subglottis.* Horizontal hemilaryngectomy is the excision of supraglottis only, also known as supraglottic laryngectomy.* So, it is quite obvious, in supraglottic cancer horizontal hemilaryngectomy should be done to remove supraglottis.Treatment of supraglottic canceri) T1 lesions- respond well to radiation. They can also be excised with CO2 laser.ii) T2 lesions- voice conserving supraglottic partial hemilaryngectomy with or without neck dissection if lung function is good, otherwise radiotherapy can be given to the primary cancer and the nodes.iii) T3 and T4 lesions- often require total laryngectomy with neck dissection and post operative radiotherapy.
Vertical hemilarygectomy
Horizontal partial hemilaryngectomy
Total laryngectomy
Radiotherapy followed by chemotherapy
Larynx