Perichondrial flap to prevent chondritis and cartilage necrosis in salvage vertical partial laryngectomy for recurrent glottic carcinoma after irradiation: a new procedure.
CONCLUSIONS
We conclude that our new closure method using the posterior- and inferior-based perichondrial flap may diminish the chance of development of chondritis in salvage vertical partial laryngectomized patients with recurrent glottic cancer.


OBJECTIVE
Post-radiation laryngeal chondritis with resultant cartilage necrosis is one of the most dreaded complications of radiotherapy treatment of glottic carcinoma. In the case of salvage vertical partial laryngectomy, the risk of its development may be increased. We introduce a new posterior- and inferior-based perichondrial flap procedure to prevent postoperative chondritis after salvage vertical partial laryngectomy.


METHODS
The perichondrium is incised along the midline and upper border of the thyroid cartilage, but not along the inferior border, unlike the conventional method. Then, the posterior- and inferior-based perichondrial flap, along with the cricothyroid muscle fascia, is elevated from the midline. For closure of the pharyngeal lumen, the outer perichondrium of the lesion side is sutured to the inner perichondrium of the contralateral side to protect the larynx from pharyngeal secretion. The utility of this procedure is reviewed retrospectively in 10 patients with locally persistent or recurrent squamous cell carcinoma of the vocal cord after failed laryngeal radiation therapy between 1994 and 2001.


RESULTS
None of our patients developed chondritis postoperatively. The interval between the operation and removal of the tracheostomy tube ranged from 8 to 23 days (mean 12 days). Patients were able to swallow without aspiration within 7-22 days of the operation (mean 10 days). Discharge from hospital was possible after a mean recovery period of 11 postoperative days.
Lim
Young Chang
YC
Department of Otolaryngology-Head & Neck Surgery, Konkuk University College of Medicine, Seoul, South Korea.
Son
Eun Jin
EJ
Kim
Kyubo
K
Kim
Kwang Moon
KM
Choi
Eun Chang
EC
D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery*; D002357:Cartilage Diseases / Q000517:prevention & control*; D003413:Cricoid Cartilage / Q000473:pathology* / Q000528:radiation effects / Q000601:surgery; D003679:Deglutition / Q000502:physiology; D000071938:Fasciotomy; D005500:Follow-Up Studies; D005931:Glottis / Q000528:radiation effects / Q000601:surgery*; D006801:Humans; D007818:Laryngeal Diseases / Q000517:prevention & control*; D007821:Laryngeal Muscles / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013536:Suture Techniques; D013957:Thyroid Cartilage / Q000473:pathology* / Q000528:radiation effects / Q000601:surgery; D013997:Time Factors; D014139:Tracheostomy / Q000295:instrumentation; D014827:Vocal Cords / Q000528:radiation effects / Q000601:surgery