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Extended Open Partial Laryngectomy with Titanium-Based Laryngeal Framework Reconstruction: Surgical Technique and Treatment Outcomes

Piotr Wójtowicz, Olga Jurek-Matusiak, Jan Ratajczak and Antoni Krzeski

Objective: To present surgical technique and treatment outcomes after extended open partial laryngectomy with titanium-based laryngeal framework reconstruction performed on 8 patients with T2-T3 squamous cell cancer of larynx.

Method: To evaluate respiratory, phoniatric and swallowing function of larynx, titanium plate tolerance and cancer treatment outcomes 3 years after used operating procedure.

Results: The procedure was uneventful and the airflow through the reconstructed part of the larynx was undisturbed in all cases. The titanium plate ensured airway patency and was well tolerated, except for one case, where it was explanted due to proliferation of granulation tissue on the skin over the plate. The anterior wall did not collapse following device explantation. Phoniatric evaluation demonstrated no social impact of patient vocal handicap. 5 patients reported mild vocal disability and 3 moderate vocal disabilities in the Voice Handicap Index. None of them developed dysphagia. Most patients reported high and very high swallowing-related quality-of-life in the M.D. Anderson Dysphagia Inventory (mean score of 79). Complete laryngectomy was performed in 2 patients due to local recurrence and cervical lymphadenectomy with subsequent radiotherapy was performed in 1 patient due to regional recurrence.

Conclusion: Extended open partial laryngectomy with titanium-based laryngeal framework reconstruction may be one of way of treatment of intermediate-stage laryngeal cancer, especially with a limited endoscopic access to the tumor or suspected thyroid cartilage infiltration, which preserves physiological laryngeal function. This cancer stage is an indication for complete laryngectomy, so the procedure represents organ sparing approach