Guide Practical Guide to Neck Dissection: Focusing on the Larynx

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Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context.

These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers. Guidelines for the surgical management of laryngeal cancer : Korean society of Thyroid-head and neck Surgery. N2 - Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer.

Department of Otorhinolaryngology-Head and Neck Surgery.

Mini Review ARTICLE

Abstract Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. Fingerprint Laryngeal Neoplasms. Thyroid Gland. At endoscopy the tumor may be obscured by the laryngocele itself. Mechanism of a laryngocele The laryngeal ventricle v is a slit-like opening between the false and true vocal cords image far left. It is the anatomic landmark between supraglottis and glottis.


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The ventricle extends laterally and then cranially into the paraglottic space. When the opening of the laryngeal ventricle is completely obstructed by tumor, the mucosa in the paraglottic space continues to produce fluid. This results in a fluid-filled internal laryngocele. Eventually the paraglottic space becomes filled up and the internal laryngocele will become external by extending outside of the larynx through the thyro-hyoid membrane. When the opening of the laryngeal ventricle is partially obstructed, a pressure-valve mechanism may result in an air-containing internal laryngocele which may, eventually, become external right image, red arrow.

On the left, a CT-image at the level of the thyroid cartilage. There is an irregular mass centered in the right piriform sinus. This mass is in the visceral space. In this region the most common tumor is a squamous cell carcinoma. This was proven at biopsy. Notice the retropharyngeal space yellow arrow. This is a virtual space containing only some fat. Squamous cell carcinoma 2 On the left, contiguous slices in a craniocaudal direction at the level of the larynx.

Study this case, which is quite similar to a previously discussed case and then continue reading. Step 1: Which space On the left a patient with a swelling on the left side of the neck, which has existed for years. The swelling is adjacent to the left lamina of the thyroid cartilage. The strap musculature seems to be draped over the lesion blue arrow. Therefore this lesion lies within the visceral space. Step 2: Normal contents Analysis of the normal anatomical contents of the visceral space rules out many possible tissues and organs from which this pathology may arise:. By exclusion we can say that this mass arises either from the thyroid gland or the parathyroid glands.

Step 3: Pattern recognition and clinical information On the chest film we notice a displacement of the trachea to the right by an upper mediastinal mass. So the mass is located within the visceral space and extends into the anterior mediastinum, since the trachea is located within the anterior mediastinum. It is well-defined towards the surrounding fat and there are a few scattered coarse calcifications. When we combine these findings, we recognize the radiological pattern of a benign multinodular goiter.

This diagnosis is compatible with the clinical information that the swelling in the neck has been present for years. On the left axial T1- and T2-weighted images at the level of the hyoid bone. There was no enhancement on the post Gadolinium study not shown It is a midline cystic lesion, party external and partly internal to the hyoid bone and located in the visceral space.

The lesion is embedded in the strap musculature.

Normal anatomy and pathology

It is unlikely that this lesion arises from the trachea, thyroid gland, parathyroid glands or recurrent laryngeal nerve, since these structures are located more caudally. Lymph nodes are usually seen in the subcutaneous fat around the larynx. By exclusion a thyroglossal duct cyst is the most likely diagnosis.

On the left an example of a paramedian thyroglossal duct cyst. This lesion not in the midline, but the key finding is that this lesion is cystic and embedded in the strap musculature. Thyroglossal duct cyst 3 When the diagnosis thyroglossal duct cyst is made, always check if there is a thyroid in the normal position. The thyroid anlage may never travel along the thyroglossal duct. In that case it stays at the tongue base. In these rare cases, the patient has a so-called lingual thyroid.

On the left another paramedian thyroglossal duct cyst.

Laryngeal Preservation: All Patients Need a Voice

On the left, a child with a lingual thyroid. This is the only functioning thyroid tissue that this child has. It would be a disaster if such a 'lesion' were to be excised. On the left images of a three-year old girl with a slowly enlarging tumor in the midline. On ultrasound a hypoechoic ovoid smooth bordered lesion is seen at the level of the hyoid bone and slightly right off midline left image. During US examination, the lesion moves simultaneously with extrusion of the tongue.

Cystic nature and close relation to the hyoid bone makes thyroglossal duct cyst the most likely diagnosis. Notice that a normal thyroid gland is present right image. The carotid space extends from the skull base to the aortic arch. It transverses the suprahyoid and infrahyoid neck into the anterior mediastinum. Step 1: Which space On the left a patient with a swelling on the left side of the neck.

Study the MR-image at the level of the supraglottic larynx and decide in which space the lesion is located. The swelling is centered between the external and internal carotid artery.

ASCO SPECIAL ARTICLE

Notice that these vessels are compressed. Evidently this lesion must be located in the carotid space. Please note that there is a smaller, but identical, lesion present, located in the right carotid space.


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Step 2: Normal contents Now we must try to figure out the normal anatomical source that has caused this pathology. Once again, we use exclusion:. Therefore it is very likely that the bilateral swellings of this patient are coming from these neural structures. Now we are down to a fairly limited and space-specific differential diagnosis see next image.

Paraganglioma 2 On the left images of a year old female with a mass on the right. This lesion is located between the internal and external carotid artery and therefore is a neural tumor. The differential diagnosis is limited to tumors arising from the vagus nerve and sympathetic plexus. On CT and color doppler the mass is clearly hypervascular and the only possible diagnosis is a paraganglioma. On the left images of a year old female with a nontender mass at the left mandibular angle.

Practical Guide to Neck Dissection

Step 1 The mass is located in carotid space. Step 2 Anatomical contents: carotid artery, internal jugular vein, vagus nerve, sympathetic plexus, lymph nodes Level and congenital remnants of the 2nd branchial cleft.

Surgical Treatment for Advanced Cancer of the Larynx

Thrombosis of the internal jugular vein is an under-diagnosed condition that may occur as a complication of head and neck infections, surgery, central venous access, and intravenous drug abuse. An infected jugular vein thrombus caused by extension of an oropharyngeal infection is referred to as Lemierre's syndrome. This is a bacterial infection that may have severe morbidity or even fatal outcome, as eventually septic emboli may spread to the lungs. On the left a patient who had undergone a total laryngectomy several years previously.

The present complaint is a painful swelling on the left side of the neck since one day.