Name of the Procedure:

Laryngectomy; subtotal supraglottic, without radical neck dissection

Summary

A subtotal supraglottic laryngectomy is a surgical procedure aimed at removing a portion of the larynx (voice box), specifically the area above the vocal cords, without performing an extensive neck dissection to remove lymph nodes.

Purpose

This procedure addresses cancers or severe conditions affecting the supraglottic region of the larynx. The goal is to eliminate cancerous tissue while preserving as much normal function as possible, potentially improving breathing, swallowing, and speech.

Indications

• Diagnosis of supraglottic laryngeal cancer
• Symptoms like persistent hoarseness, difficulty swallowing, or breathing
• Tumors localized to the supraglottic region without extensive neck involvement

Preparation

• Fasting: Patients may need to abstain from eating or drinking for 8 hours prior
• Medication adjustments: Blood thinners and certain medications may need to be paused
• Diagnostic tests: Imaging studies (CT, MRI), biopsy, and lab tests to confirm cancer staging

Procedure Description

1. Anesthesia is administered, usually general anesthesia.
2. An incision is made in the neck to access the larynx.
3. The surgeon removes the supraglottic section of the larynx while preserving the vocal cords.
4. The remaining larynx is reconstructed to maintain as much function as possible.
5. No radical neck dissection is performed, focusing solely on the larynx area.
6. Surgical tools may include scalpels, electrocautery devices, and specialized laryngoscopy instruments.
7. Sutures and sometimes temporary tracheostomy tubes are placed to aid in breathing.

Duration

The procedure typically takes 2-4 hours.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Surgeons specialized in head and neck surgery
• Anesthesiologists
• Operating room nurses
• Surgical technicians

Risks and Complications

Common risks include bleeding, infection, and difficulty swallowing. Less common but serious risks involve breathing problems, aspiration pneumonia, and fistula formation. Management may include antibiotics, additional surgeries, or supportive care.

Benefits

The primary benefit is the removal of cancerous tissue with a potentially curative intent. Improved breathing and swallowing functions can usually be realized within a few weeks post-surgery, enhancing the patient's quality of life.

Recovery

• Post-procedure care includes hospital stays for monitoring, usually 5-10 days.
• Patients may require a temporary tracheostomy and feeding tube.
• Pain management through prescribed medications.
• Speech and swallowing therapy may be necessary.
• Follow-up appointments to ensure proper recovery and address any complications.

Alternatives

• Radiotherapy or chemoradiation: Used in early-stage cancers or when surgery is not an option.
• Total laryngectomy: More extensive surgery with higher functional loss.
• Palliative care: Focused on symptom relief in non-curative scenarios. Each alternative has its trade-offs in terms of invasiveness, recovery time, and functional outcomes.

Patient Experience

During the procedure, the patient will be under general anesthesia and won’t feel anything. Post-surgery, there may be discomfort and pain managed by medications. Patients may experience temporary changes in voice and feeding methods, requiring supportive measures and therapy.

Pain management strategies, detailed post-op instructions, and a comprehensive care team will ensure comfort and promote recovery.