Head and Neck ImagingLaryngectomy
total or partial surgical removal of the larynx. Complete removal of the larynx may be required as primary treatment of extensive laryngeal cancer or for salvage of
tumour recurrence after radiation treatment or failed partial laryngectomy. Traditional partial laryngectomies include horizontal supraglottic laryngectomy and vertical hemilaryngectomy, but more complex surgical techniques are now being employed.
Preoperative imaging is useful to determine the feasibility of partial laryngectomy. For example, the line of resection in a horizontal supraglottic laryngectomy goes through the laryngeal ventricles, so the key to the feasibility of this procedure is the inferior tumour extension which can occur entirely beneath an intact mucosal lining (and thus subclinically). In such cases, the ventricle is the most important landmark for the radiologist. If a supraglottic cancer spreads inferiorly along the ventricle, in the paraglottic space at the level of the true vocal cord, then speech conservation surgery will not be possible (Fig.1).
After total laryngectomy, the pharynx may be closed primarily or, if insufficient tissue is available, a musculocutaneous flap is used to close the pharyngeal defect (see also pedicled flap) (Fig.2).
Postoperative imaging is useful to confirm the presence of any tumour recurrence and determine its local extent. A reliable imaging finding in recurrent tumour is an enhancing soft tissue mass (Fig.3); after partial laryngectomy, destruction of residual laryngeal cartilage may be seen. Routine postoperative surveillance of asymptomatic patients with CT or MRI is probably not cost-effective.
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Axial contrast-enhanced CT image. After total laryngectomy, the pharyngeal defect was closed with the aid of a musculocutaneous pedicled flap (asterisk) (pectoralis major flap; the muscle is largely atrofied, explaining the fatty density). Remnant of thyroid gland (arrow), partially removed during this procedure, should not be mistaken for recurrent cancer.
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Laryngectomy, Fig.1 | | Laryngectomy, Fig.2 | | Laryngectomy, Fig.3 |