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Abstract
Near total laryngectomy (NTL) is an oncologically safe voice preserving procedure for properly selected cases of advanced cancer of the larynx and hypopharynx with no invasion of the interarytenoid space and limited invasion of the subglottis and it is also a useful option for the surgical treatment of patients who are candidates for conservation surgery but will not tolerate it for reasons of comorbidities such as lung disease or age. The survival is comparable with that of patients submitted to total laryngectomy, regarding the extent of the lesion.
Near total laryngectomy enlarges the speech rehabilitation options for the laryngectomzied patient by adding aphysiologic, non prosthetic tissue technique .
Proper assessment of the larynx preoperatively, through detailed endoscopy and CT scan and intraoperatively for detection of tumor spread is vital for proper selection of cases legible for the procedure.
Follow up of the patients postoperatively both clinically and via endoscopy and CT scan of the neck is important to detect recurrence locally or regionally as early as possible.
The achieved voice results were excellent and the complication rate was acceptable and proved to be similar to other published results. Serious aspiration was not encountered and the other co-morbidities could be delt was conservatively. Radiotherapy did not affect shunt function . NTL did not delay starting postoperative adjuvant therapy sessions. Still, NTL is not a salvage procedure and is not recommended after radiation failure or recurrence. NTL is not a substitute for total laryngectomy or conservative laryngeal operations. Actually, it provides the missing link between these two extremes .
It is a biological shunt with a mantenance-free valving mechanism brough about by the integrity of the recurrent laryngeal nerve and the intrinsic laryngeal muscles on the contralateral side .
Esophageal Speech, TEP, and electromechanical aids all remain options for NTL patients who do not achieve shunt speech, provided the patient’s spirit and motivation are sustained.
By eliminating the prospect of aphonia, NTL removes one of the barriers to the patient’s acceptance of appropriate curative primary surgery for this disease .
The short follow –up available prevented us from drawing oncologic conclusions.