gms | German Medical Science

Introduction: A 44-year-old male patient, chronic heavy smoker, complaining of change of voice and pain with swallowing for 1 month with gradual onset and progressive course. flexible laryngscopy and C.T scan: revealed a supra glottic mass extending to the false cords & extending anteriorly in the pre-epiglottic space & query reaching the hyoid bone, bilateral free vocal cords, bilateral free pyriform fossae, and few left upper deep cervical lymph nodes.

Clinical staging: cT3N1M0.

Operation details: Apron incision with bilateral lateral selective neck dissection (level 2a & b, 3, 4). A supra-glottic laryngectomy was tried but the tumor was found reaching both vocal cords sparing both arytenoids which were freely mobile so the decision was changed to supra cricoid laryngectomy (SCL) with crico-hyoido-pexy. It was found that the tumor was encasing the inner surface of the hyoid bone so we decided to remove the hyoid bone with the specimen, so the decision was to give the patient another chance for voice preservation by doing crico glossopexy as the patient is young with good pulmonary function.

Special tips during doing this technique: Avoid suturing the mucosa of the tongue to the remaining laryngeal structure. Instead, place the suture through tongue musculature. Always perform cricopharyngeal myotomy to aid in deglutition.

Post-operative details: The pathological report staging was pT3N0M0, the tracheostomy tube was removed after 2 weeks, the patient is disease free till now after 1 year with perfect feeding and swallowing and very minimal aspiration with video fluoroscopy barium swallows follow up.

Conclusion: It is therefore suggested that this technique (SCL-Cricoglossopexy) may be a feasible technique concerning surgery and post-operative rehabilitation.

Unterstützt durch: Kasr Alaini Hospitals, Faculty of Medicine, Cairo University.

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