Transoral Laser Microsurgery in Carcinomas of the Oral Cavity, Pharynx, and Larynx

Jochen A. Werner, MD, Anja A. Dünne, MD, Benedikt J. Folz, MD, Burkard M. Lippert, MD

Disclosures

Cancer Control. 2002;9(5) 

In This Article

Hypopharyngeal Carcinomas

The pretherapeutic assessment includes an endoscopic examination (under general anesthesia) and computed tomography imaging. The results of these investigations determine if a partial resection is possible and justified. Tumor extension on the mucosal surface as seen by the examiner is rarely a reflection of true tumor extent. Carcinomas of the pyriform sinus can invade the paraglottic and pre-epiglottic space, the area of the arytenoid cartilages, the thyroid cartilage, or the soft tissues of the neck without any evidence of such invasion on endoscopy. Only extensive infiltration (for example, into the cricoarytenoid joint) will clinically indicate the deep invasion of the tumor by impaired mobility or fixation of the arytenoid cartilage.

If laser surgical resection is indicated, a step-by-step resection of the tumor in a craniocaudal direction is generally recommended. The tumor is removed "blockwise" and layer by layer. The dissection proceeds inferiorly as far as good exposure and accessibility of the tissues in the dissection plane are assured. The tumor is divided into a mosaic-like pattern by horizontal and vertical cuts. The border between tumor and healthy tissue can be identified on the tissue section. The bivalved laryngoscope is generally positioned so that a margin of normal tissue of approximately 10 mm remains between the blade of the speculum and the edge of the visible tumor. The incision into the mucosa must be made under the highest possible magnification of the microscope.[19]

In summary, tumor and normal tissue can be particularly well differentiated in the hypopharynx. Relatively wide resection margins of 5 to 10 mm can be achieved in this area without major functional consequences caused by additional loss of tissue, thus resulting in safer tumor resections. In all hypopharyngeal tumors, spontaneous healing with complete epithelization of the wound occurs after their resection. Healing is usually complete within 6 weeks with good functional results.

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