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Paraglottic Space in Supracricoid Laryngectomy
Min-Sik Kim, MD;
Dong-Il Sun, MD;
Kyung-Ho Park, MD;
Kwang-Jae Cho, MD;
Young-Hak Park, MD;
Seung-Ho Cho, MD
Arch Otolaryngol Head Neck Surg. 2002;128:304-307.
Background Paraglottic space (PGS) is a connective tissue compartment of the larynx
and is important in the extension of laryngeal cancer. It communicates with
the preepiglottic space superiorly and with the extralaryngeal region inferiorly
through the gap within the cricothyroid membrane. Transglottic cancer of the
larynx, which spreads within PGS, is characterized by a high incidence of
laryngeal skeleton invasion and of cervical metastasis. Determining the correct
stage of transglottic cancer of the larynx is difficult, leading to therapeutic
failure of partial laryngectomy in some cases.
Objective To clinically confirm a pathologically complete resection of PGS from
the piriform sinus mucosa by supracricoid partial laryngectomy in laryngeal
cancers involving PGS.
Materials and Methods Eight patients with transglottic cancer whose cancer was confirmed clinically
and pathologically at stages T2b or higher underwent supracricoid partial
laryngectomy. During supracricoid partial laryngectomy, we performed a sharp
dissection of PGS from the piriform sinus mucosa to obtain a complete resection
margin while preserving the piriform sinus mucosa. Microscopic evaluation
of the specimens was made for the invasion of PGS and the safe margin distance
from the piriform sinus mucosa.
Results Pathological cancer invasion of PGS was confirmed in 7 of 8 patients
and a sufficient pathological margin from tumor invasion to the piriform sinus
mucosa was obtained. The average safety margin was 10.3 mm.
Conclusion Supracricoid partial laryngectomy could be considered a safe surgical
modality for cancers not extending to PGS.
From the Department of Otolaryngology–Head and Neck Surgery,
College of Medicine, The Catholic University of Korea, Seoul, Korea.
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