New surgical technique for larynx reconstruction

Jul 29 2004

Professor Pierre Delaere (Otorhinolaryngology Department, K.U.Leuven) has in the past decade developed a new surgical technique for larynx reconstruction.

In an increasing number of cases, this innovative technique can save the larynx in patients suffering from vocal cord cancer. Patients are able to breathe, swallow and speak normally following the operation, something that was previously impossible since the entire larynx frequently needed to be removed, even if only one vocal cord was affected.

The larynx separates the digestive system and the respiratory system. If the larynx is removed then the separation must be effected in some other way. Persons without a larynx can still eat if the esophagus is connected directly to the oral cavity. However, this means that breathing through the mouth and nose becomes impossible and a permanent opening (stoma) for the trachea has to be made in the patient’s neck. This is a very conspicuous intervention and results in many problems of adaptation. Speech is still possible using an apparatus placed in the stoma, but the patient must cover the opening with his finger.

Prof. Delaere investigated why the larynx was completely removed in almost every case. In part, this is a result of the complex structure of the larynx itself. If part of the larynx is removed, two main problems arise: new tissue must be found to replace what has been removed, and the supply of blood must be optimal to ensure that the new tissue does not die.

Prof. Delaere found solutions to both these problems. Since the human trachea is five centimeters too long, this extra length can be stretched out and put in place of the part of the larynx which was removed, as long as a sufficient blood supply is maintained. The solution to this was to take a bit of tissue from the forearm, wrap it around the trachea and connect it with the blood vessels in the neck. Following such an operation, patients can breathe as before through the mouth and nose, and they still have their sense of smell. In most cases they have no problem swallowing and can still speak naturally, though with only one vocal cord the voice will be softer and hoarser.

After many successful operations at K.U.Leuven University Hospital, Prof. Delaere’s technique is now past the experimental phase and is described in his book, Laryngotracheal Reconstruction: From Lab to Clinic. Now the complete removal of the larynx can be avoided in one in five cases of laryngeal cancer. An early diagnosis is of crucial importance since the prognosis gets worse as the tumor further develops.

The incidence of laryngeal cancer continues to rise. Of all types of cancer, 3.5% are cancers of the larynx. In 90% of these cases, smoking is the main cause, sometimes combined with excessive alcohol use.