LARYNGEAL PRESERVATION IN TOTAL GLOSSECTOMY

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  • 舌全摘例における喉頭保存の限界

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Abstract

Total glossectomy is the most mutilating of all surgical procedures performed on the head and neck. Because of the anatomic and physiologic intricacies of the tongue, this technique involves a variety of problems, such as preservation of the larynx, reconstructive methods, and rehabilitation, as well as curability. These problems are frequently compounded by additional surgery that may needed to ablate the tumor, usually together with neck dissection.<br>Forty-five consecutive patients who underwent total glossectomy for advanced or recurrent carcinoma of the oral cavity and oropharynx were evaluated. Four patients presented with T3 disease, 21 patients with T4 disease, and the remaining 20 patients had recurrent or persistent disease after prior treatments. In combination with total glossectomy, total laryngectomy was performed primarily in 30 patients (67%), and secondarily in 1 patient (2%). In patients with the larynx preserved, ancillary procedures, such as laryngeal suspension, laryngoplasty, and cricopharyngeal myotomy, were advocated to facilitate postoperative deglutition.<br>In laryngeal preservation, the patient's cardiovascular condition and psychological motivation must be considered. And, preservation of the pharyngeal constrictor muscle and the thyrohyoid nerve is important, as well as preservation of the superior laryngeal nerve and mandibular continuity.<br>From the viewpoint of the extent of oropharyngeal excision, the larynx can be preserved when both posterior and unilateral oropharyngeal walls are not affected. Ancillary procedures (laryngeal suspension, laryngoplasty, epiglottopexy and cricopharyngeal myotomy, etc.) may be advocated to facilitate postoperative swallowing. Currently a rectus abdominus myocutaneous flap is preferable to restore the defects after a glossectomy preserving the larynx.

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