Functional outcomes after supracricoid modified partial laryngectomy

ABSTRACT Open Partial Horizontal Laryngectomy (OPHL) OPHL is a standard surgical procedure consisting of a resection followed by reconnection of preserved structures: cricoid-hyoid-epiglottis (CHEP) in OPHL IIa, or cricoid-hyoid (CHP) in OPHL IIb. The main objective is the preservation of neoglottic functions, such as laryngeal functions in terms of voice quality, swallowing and breathing, restored after physiological rehabilitation. Moreover, no permanent tracheostomy is required after performing an OPHL. The crucial point in this surgical procedure is preserving at least one functional and mobile cricoarytenoid unit, including arytenoid cartilage, cricoid lamina, posterior and lateral cricoarytenoid muscles, superior and recurrent laryngeal nerves. This represents the maximum extent of resectability and allows to preserve pharyngolaryngeal sensitivity in order to allow airways protection and adequate deglutition stimulus; maintain physiologic coordination during deglutition and reconstruct a functional neoglottic sphincter and adequate airways patency [9]. The aim of this study is therefore to retrospectively evaluate neoglottic functionality, in terms of voice quality, swallowing and breathing, after modified OPHL type II according to the Guerrier technique, in a group of selected T2 and T3 patients. A multicentre prospective randomized study was conducted on 59 patients affected by non-previously treated T2 and T3, glottic and transglottic squamous cell carcinoma, and treated with modified OPHL IIa or OPHL IIb (Guerrier's technique) in the University Departments of Otorhinolaryngology of Palermo and Catania (Sicily-Italy) Our study shows that Guerrier's OPHL II is a well-tolerated procedure with generally good functional outcomes, although some voice and swallowing complaints persist long term. If patients are properly selected, this technique allows oncological radicality: it is the least aggressive surgical technique as pyriform sinuses do not need to be detached and, consequently, repositioning is not required; there is actually no risk of damaging the laryngeal nerve and surgery times are quicker than others. This can means better results in terms of functions, such as swallowing, as is shown by the quick resumption of oral feeding. A contraindication is still present, in terms of safety and oncological radicality in the case of uncertainty regarding paraglottic space invasion; this technique may be reserved for the lesser or non-involved side. Within 3 years from surgery, no patient reported any restrictions in liquid and solid feeding.