Laryngeal surgery is usually performed by an ENT specialist. Surgical treatment may be necessary for various diseases of the larynx. A basic distinction can be made between laryngeal surgery due to a tumor or laryngeal surgery that affects the function of the larynx. Find information and laryngeal surgery specialists here.
Functional laryngeal surgery is used to
Another functional laryngeal operation is the expansion of the larynx in cases of breathlessness caused by bilateral paralysis of the vocal cords. A distinction must be made here between temporary and permanent paralysis of the vocal cord nerves.
In the case of temporary vocal cord paralysis, a vocal cord can be moved to the side using a special suturing technique. This creates space in the larynx. The Lichtenberger operation is used here, for example. If the function of the vocal cord nerves returns, the sutures are removed after approx. one year as part of a minor laryngectomy.
If there is no success, another endoscopic laryngectomy should be performed after about a year. The surgeon then removes part of the cartilage of the larynx (lateral fixation with arytaenoidectomy).
If the permanent injury is confirmed, this surgical technique is also recommended without a waiting period.
The anatomy of the larynx and vocal cords © bilderzwerg | AdobeStock
Malignant tumors in the larynx are also known as laryngeal carcinoma. It occurs most frequently in men aged 50 and over. Most of those affected are smokers.
Laryngeal carcinoma is most commonly characterized by hoarseness, as the vocal folds are often affected. Tumors on the vocal folds are therefore usually detected early and can be easily cured. For this reason, any hoarseness that persists for longer than 6 weeks should be clarified by an ENT specialist using laryngoscopy.
If the tumor is located above or below the vocal folds and does not reach them, it can grow unnoticed for longer. It then sometimes only becomes apparent through
noticeable.
If laryngeal cancer is suspected, apanendoscopy of the upper airways and alimentary canals is absolutely necessary. If a tumor occurs in the larynx, in around 10 percent of cases there are other tumors elsewhere. During panendoscopy, tissue samples are taken from the tumor and sent for histological examination.
During the laryngoscopy, the patient lies on their back and is artificially ventilated via a special breathing tube. The doctor uses a microscope to better assess the fine structures in the larynx. With the help of micro instruments, he takes a tissue sample.
With this laryngectomy technique, a laser can also be connected to the microscope to perform laser surgery.
An ENT doctor performing a laryngoscopy under general anesthesia.
There are several surgical options available for the treatment of tumors in the larynx. Surgical procedures that preserve a functional part of the larynx can be divided into
In many patients, laryngectomy can be performed "from the inside", i.e. endoscopically through the mouth and throat without externally visible incisions. Either fine instruments or lasers are used for this purpose.
The laser has the great advantage that it immediately obliterates the severed tissue when cutting, resulting in less bleeding. This leads to a better overview during surgery and therefore to increased precision and greater protection of the remaining tissue.
The use of lasers can sometimes avoid the so-called "major" surgery from the outside with the costly reconstruction of the surgical defect by means of tissue transplantation. As a result, the frequency of total laryngectomies has fallen in recent years. Compared to the past, it is more often possible to preserve the larynx despite extensive tumor growth.
In addition, laser surgery can usually be performed again if a tumor recurs. By removing the tumor under microscopic control, it is possible to avoid removing too much healthy tissue.
The finest scissors and forceps are used without a laser. The surgeon inserts them through the open mouth up to the larynx. With these micro instruments, a particularly gentle laryngectomy can be performed under the operating microscope.
The tumor is not always fully visible endoscopically. This would not guarantee safe removal of the tumor "from the inside". In this case, laryngectomy must be performed "from the outside".
This means that an incision through the skin of the neck and opening of the laryngeal skeleton is necessary. In cases where the tumor is very extensive, laryngeal surgery is no longer possible while preserving essential structures required for laryngeal function. In this case, the entire larynx must be removed, a so-called total laryngectomy.
Possible localization of laryngeal carcinomas © Henrie | AdobeStock
The various methods of laryngectomy for laryngeal tumors are described individually below:
Decortication of the vocal fold/vocal fold stripping
The surgeon removes the mucous membrane of the vocal fold endoscopically while sparing the vocal cord muscle. This procedure is used for precancerous lesions or very circumscribed carcinomas.
Choidectomy
The affected vocal fold is removed either endoscopically or after temporary splitting of the thyroid cartilage from the outside, taking the vocal cord muscle with it. This usually results in a voice that is easy to understand but rough.
This procedure is recommended for carcinomas of the vocal fold with
is indicated. The laser should also be preferred here.
Partial laryngectomy
There are many forms of partial laryngectomy. Each type of removal has its own specific advantages and disadvantages. Essentially, however, a distinction can be made between horizontal and vertical partial resections.
This type of procedure is necessary if the tumor is too extensive to perform a chordectomy (see above). This results in good to adequate vocal performance.
If the tumor is completely manageable endoscopically, partial resections can also be performed with a laser. Laser procedures are usually gentler and the cosmetic result can be more favorable.
Vertical partial laryngectomy
Vertical partial laryngectomy is performed for unilateral tumors. The surgeon removes a vertical section of the thyroid cartilage, and possibly also the cricoid cartilage. The complete removal of both the vocal fold and the pocket fold on one side is also possible.
It may be necessary to make a tracheotomy to protect the airways after laryngectomy. However, in most cases this can be closed again after a few days.
Horizontal partial laryngectomy
Tumors that are located above the vocal cords are treated using horizontal partial laryngectomy. Both vocal folds and the cartilage remain intact.
In this type of laryngectomy, the surgeon first cuts the thyroid cartilage horizontally approximately in the middle. He then removes the lower part of the cartilage with the tumor tissue attached to it.
Frontolateral partial laryngectomy
This method is used for tumors that have grown into the anterior commissure. The surgeon removes the affected parts of the anterior commissure and the remaining affected vocal folds.
Total removal of the larynx (laryngectomy)
If a partial resection is no longer possible due to the size of the tumor, a complete removal of the larynx is necessary. A laryngectomy is also often necessary after a recurrence of laryngeal cancer (recurrence) following partial resection or primary radiotherapy.
In this type of operation, the air and food passages are completely separated from each other. This makes the patient a so-called "throat breather", as a permanent "tracheostoma" (tracheotomy) is necessary.
A ventilation tube is a breathing aid. The tube is inserted into the trachea through a laryngeal incision and fixed to the neck with a plastic cuff © Sherry Young | AdobeStock
It is also possible to learn to speak again after complete removal of the larynx. There are several options available for this.
In esophageal replacement or "belching speech", air is pressed into the upper esophagus, which is then released back into the throat in a controlled manner. The vibration of the mucous membrane of the lower pharynx produces a sound that enables vocalization. However, learning this speaking technique requires several months of training. The great advantage is that the patient can speak independently of aids.
Alternatively, a surgically created short-circuit connection between the windpipe and pharynx can help. A silicone voice prosthesis is inserted into this, e.g. Provox prosthesis or Blom-Singer prosthesis. This enables most patients to speak again quite quickly.
However, they are often dependent on aids, such as certain valves on the tracheotomy, or have to close the tracheotomy with one hand in order to speak. Furthermore, the prostheses require regular care and need to be changed from time to time. Otherwise they gradually lose their function due to material fatigue or soiling.
A third option for voice rehabilitation is the use of a so-called electric larynx. It uses an electronic speech aid to generate an audible vibration (so-called primary sound), which is pressed against the throat. The vibrations are then transmitted to the floor of the mouth or throat.
By modulating the sound with tongue and throat changes, the patient can speak in this way.
The chances of recovery are best if the tumor is detected early and treated accordingly.
In many cases, laryngeal cancer affects the vocal cords. Hoarseness is therefore an early warning sign. The prognosis for most laryngeal cancers is therefore better than that of throat cancer, for example, which can often grow unnoticed for a long time.
Almost 90 % of all patients can be cured if
This percentage is reduced to < 50 % in the case of large, advanced laryngeal cancer.
After an endoscopic laryngectomy, in some cases it is advisable to have another examination around 6 to 8 weeks later. This is performed under general anesthesia and is used to take tissue samples. This allows the doctors to check whether a tumor is forming again.
In addition, regular tumor follow-up by an ENT specialist is essential.
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