Near-total laryngectomy following failure after supracricoid partial laryngectomy.

INTRODUCTION Near-total laryngectomy (NTL) provides a functional alternative to total laryngectomy (TL) in T3-T4 laryngeal and hypopharyngeal cancer. It was initially advocated in extended glottic carcinoma and in hypopharyngeal carcinoma. More recently, the utility of Pearson’s NTL for supraglottic, pharyngeal, and base of tongue cancer has been reported. Its application is also described for patients who are candidates for conservative partial surgery but are compromised physiologically due to age or poor general health, and for patients in whom tumor extension would not permit safe conservative surgery. On the other hand, supracricoid partial laryngectomy (SPL) with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy yields good functional and oncological results in the treatment of T1b-T2 and T3 glotto-supraglottic cancer. Good restoration of swallowing is usually recovered within 1 month after surgery. Only in a few cases the persistence of severe aspiration requires additional surgical procedures to resolve dysphagia, such as revision of the pexy followed by an intensive program of swallow rehabilitation. In case of failure to restore normal deglutition, TL is usually advised. The feasibility of the near-total procedure for severe aspiration after supracricoid hemilaryngopharyngectomy has already been reported. In this article we describe five cases of conversion from SPL with CHP to NTL in patients with severe and persistent aspiration.