Partial Laryngectomy with Cricoid Reconstruction: Thyroid Carcinoma Invading the Larynx

Laryngotracheal invasion worsens the prognosis of thyroid cancer and the surgical approach for laryngotracheal invasion is controversial. In this paper, partial full-thickness excision of the cricoid cartilage with supracricoid laryngectomy and reconstruction of existing defect with thyroid cartilage are explained in a patient with papillary thyroid carcinoma invading the thyroid cartilage and cricoid cartilage without intraluminal invasion. Surgical indication should not be established by the site of involvement in thyroid carcinomas invading the larynx, as in primary cancers of the larynx. We think that partial laryngectomy according to the involvement site and the appropriate reconstruction techniques should be used for thyroid cancer invading the larynx. 1. Introduction Well-differentiated thyroid cancers are low-grade malignancies with a good prognosis. Ten-year survival is over 80%. However, a small part of these cancers has an aggressive character and jeopardizes the patient’s life by infiltrating surrounding structures [1]. Although the rate of laryngotracheal invasion of differentiated thyroid carcinoma is about 7% [2], less than 1% infiltrates the lumen [3]. The vast majority of deaths depend on the involvement of surrounding organs or distant metastases. Therefore, local control of the disease is effective on survival rate [4]. Laryngotracheal invasion worsens the prognosis of thyroid cancer and the surgical approach for laryngotracheal invasion is controversial [5]. The more radical the surgical technique used is, the more the patient’s quality of life will be effected [4]. In this paper, partial full-thickness excision of the cricoid cartilage with supracricoid laryngectomy and reconstruction of existing defect with laryngeal cartilage are explained in a patient with papillary thyroid carcinoma invading the thyroid cartilage and cricoid cartilage without intraluminal invasion. 2. Case Report A 50-year-old male patient who underwent total thyroidectomy and neck dissection with the diagnosis of thyroid papillary carcinoma 17 years ago presented to our clinic with the complaint of swelling in a region corresponding to the thyroid compartment on the left side. A 4 × 3？cm sized hard mass was palpated on the left side at the level of cricoid on physical examination. Endoscopic examination of the larynx and vocal cord movements were normal. Ultrasonographic examination revealed a solid mass with heterogeneous internal structure that was about 4.5 × 2.5 × 4？cm in size invading the laryngeal structure. Fine-needle aspiration biopsy taken from the