10.10\ Laryngectomy

492

D.T. Ginat et al.

Procedure

Description

Imaging features

Conservative

Microsurgery

Minimally invasive excision of

CT may appear normal

small tumors using lasers. Mainly

once vocal cord tissue

used for excision of vocal cord

regenerates. On CT, a

tumors and variable portions of

defect in the vocal cord

the vocal cord (cordectomy)

may be visible, but may

appear normal once vocal

cord tissue regenerates,

resulting in a pseudocord

Vertical partial laryngectomy

Frontolateral laryngectomy:

Frontolateral

resection of vertical segment of

laryngectomy: CT shows

thyroid cartilage, one vocal cord,

vertical defect in thyroid

the laryngeal ventricle and false

lamina, with irregular

cord, anterior commissure, and

sclerotic border, absent

small anterior portion of

aryepiglottic fold,

contralateral cord

paraglottic and

preepiglottic fat, scar at

site of excised true vocal

cord that extends from the

contralateral thyroid

cartilage to the ipsilateral

arytenoid area that forms

pseudocord, tilting of

neovestibule to the side of

the major excision, and

normal subglottic larynx

Hemilaryngectomy: resection of

Hemilaryngectomy: CT

same structures as in frontolateral

shows similar findings as

laryngectomy and mucosa from

with frontolateral

the aryepiglottic fold to the upper

laryngectomy.

border of the cricoid cartilage,

Reconstruction with tissue

arytenoid cartilage, and

grafts or prostheses may

ipsilateral thyroid lamina

be identified

Horizontal laryngectomy

Supraglottic laryngectomy:

Supraglottic

resection of epiglottis,

laryngectomy: CT at the

aryepiglottic folds, false vocal

supraglottic level shows

cords, upper third of thyroid

dilated cavity. The hyoid

cartilage, and thyrohyoid

and remaining thyroid

membrane

cartilage are visible in the

same axial section. The

glottic and subglottic

structures are normal

Supracricoid laryngectomy:

Supracricoid

resection of laryngeal structures

laryngectomy: CT shows

from the cricoid cartilage to the

soft tissue replacing false

hyoid bone with preservation of

and true vocal cords and

at least one arytenoid cartilage

surrounding the arytenoid

and cricohyoidopexy or

cartilage. The neoglottis is

cricohyoidoepiglottopexy

asymmetric and has a

reconstruction

pseudocord appearance

Near-total laryngectomy

Resection of entire larynx except

CT can demonstrate the

for portions of thyroid lamina,

laryngeal remnants. A

thyroarytenoid muscle, and entire

tracheostomy in lower

arytenoid cartilage and recurrent

neck is present

laryngeal nerve on one side

493

Table 10.3 

(continued)

Procedure

Description

Imaging features

Radical

Total laryngectomy

Removal of the epiglottis,

CT shows the absence of

aryepiglottic folds, true and false

entire larynx, hyoid,

vocal cords, subglottic larynx,

variable portions of the

hyoid bone, thyroid cartilage,

tracheal rings, and part or

arytenoid cartilages, cricoid

all of the thyroid glands.

cartilage, and one or more

The neopharynx appears

tracheal rings. In addition, a

as a concentric layer of

partial or total thyroidectomy is

soft tissue. Excess tissue

often performed as well

at the anastomosis can

resemble the epiglottis

(“pseudoepiglottis”). A

tracheostomy is invariably

present

Pharyngolaryngectomy

In addition to total laryngectomy,

The flap or graft material

there is more extensive resection

that spans the surgical

of the pharynx, such that primary

defect can be visualized,

anastomosis between the

connecting the esophagus

esophagus and remaining

inferiorly with the

portions of the pharynx is not

remaining pharyngeal

feasible. Rather, flap or graft

mucosal tissue superiorly.

reconstruction is performed to

The graft has a tubular

create a neopharynx

configuration that forms a

lumen (neopharynx). A

tracheostomy is also present