General Issues with H&N Cancer

== Clinical Radiation Generators ==

Surgical Issues

Cordectomy

  • Excision of the vocal cord

Hemilaryngectomy
also called Vertical Partial Laryngectomy (VPL)
hn1.jpg
hn2.jpg
Diagram above shows: Hemilaryngectomy - one cord with ipsilateral arytenoid is removed

Operation removes

  • up to 1 cord (women) and 1/3 of contralateral cord in men
  • suprglottic structures: the false cords, epiglottis, and pyriform sinus;
  • one arytenoid may be removed when necessary.

Contraindications

  • Cricoid ring must be preserved as it is the only complete ring
    • > 8 - 9 mm subglottic extension anteriorly
    • > 5 mm posteriorly
    • extension to apex of cricoid = interarytenoid (between arytenoids)
  • On cord must be functional
    • contralateral arytenoid
  • Others (less strick contraindications)
    • completely fixed cord
    • extension into epiglottis
    • extension into false cord

Complications

  • aspiration

Total Laryngectomy

  • Removes
    • all the larynx and varying amounts of pharyngeal wall
  • Total laryngectomy = Supraglottic laryngectomy + glottis, arytenoid cartilage, and cricoid cartilage.
  • Most all receive postoperative radiation therapy one-stage reconstruction to avoid delays

Supraglottic Laryngectomy

  • Voice-sparing operation (both cords are spared)
  • Removes
    • all structures in Larynx above the vocal cords (glottis).
    • ex. hyoid bone, epiglottis, preepiglottic space, thyrohyoid membrane, superior half of the thyroid cartilage, and the false vocal cords.

Radical Neck Dissection

  • The resection included the spinal accessory nerve
  • the internal jugular vein
  • the sternocleidomastoid muscle
  • the submandibular gland

Modified radical neck dissection (MRND)

  • preservations one or more structures
  • spinal accessory nerve
  • internal jugular vein
  • sternocleidomastoid muscle
  • The preserved nonlymphatic structures should be specifically mentioned

Latissmus dorsi myocutaneous flap

  • Used for post-mastectomy reconstruction
  • Used for large H&N reconstruction

Epidemiology

HPV-16

  • most strongly associated with oropharyngeal cancer
  • less likely to occur in smokers
  • less likely to occur in drinker
  • less likely to occur in p53 carriers
  • improved disease specifc survival
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