title: 'Flaccid neoglottis' following supracricoid partial laryngectomy: laryngoscopic revision assisted by navigation system.
abstract: OBJECTIVE
  Supracricoid partial laryngectomy is a reliable laryngeal preservation procedure for tumour stage 2 and selected stage 3 to 4 laryngeal cancers. Of 70 patients thus treated, two (3 per cent) had 'flaccid neoglottis', i.e. redundant mucosa at the inner arytenoid edge which intermittently obstructed the neoglottis. We discuss the mechanism and management of this complication.
  
  
  METHODS
  The two cases are presented. A navigation system was used to assist surgery. Neoglottal spatial alteration (specifically cross-sectional area) was assessed pre- and post-operatively using three-dimensional computed tomography. Voice was also evaluated.
  
  
  RESULTS
  Inspiratory stridor and delayed stomal closure were the main symptoms. Minimum neoglottal cross-sectional area was smaller in case one than in non-affected patients. Both patients had relatively rougher and breathier voices, but had adapted well to this.
  
  
  CONCLUSIONS
  Flaccid neoglottis is mainly due to excessive anterior retraction of residual laryngeal mucosa and to excessive mucosal pliability with age. A navigation system was useful for confirmation, but the potential for incorrect image recognition should be kept in mind. Flaccid neoglottis was treatable, with improved laryngeal function.
authors: Department of Otorhinolaryngology, Kitasato University School of Medicine, Kanagawa, Japan. meijin@med.kitasato-u.ac.jp
authors: M
authors: M
authors: Nakayama
authors: Y
authors: Y
authors: Seino
authors: M
authors: M
authors: Okamoto
authors: T
authors: T
authors: Matsuki
mesh_terms: D000368:Aged; D018277:Carcinoma, Mucoepidermoid / Q000503:physiopathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000503:physiopathology / Q000601:surgery*; D002425:Cautery; D003413:Cricoid Cartilage; D005931:Glottis / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D007820:Laryngeal Mucosa / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods; D007828:Laryngoscopy; D007829:Laryngostenosis / Q000209:etiology / Q000601:surgery; D008297:Male; D011859:Radiography; D012086:Reoperation; D012135:Respiratory Sounds / Q000209:etiology; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014832:Voice Disorders / Q000209:etiology