The Cadaveric Study in the Hypopharyngeal Anatomy Framework to Assist in the Functional Laryngeal Surgery and Its Clinical Application

BACKGROUND: The determination of a functional laryngeal preservation surgery (FLPS) via an external approach on the medial wall of pyriform sinus (MWP) can be difficult, potentially limiting its utilization in general practice. The transoral laser microsurgery (TLM) often fails to salvage the hypopharyngeal cancer after concurrent chemoradiation treatment failure because of difficult direct laryngoscope introduction but patients often desires to preserve the phonatory function of the larynges. This study sought to elucidate the anatomical relationship of the MWP to the thyroarytenoid muscle (TAm), and recurrent laryngeal nerve (RLN), thereby facilitating a preoperative evaluation if a FLPS is justified without violating the surgical oncology principle. METHODS: This study was performed using 10 human cadavers (5 male and 5 female), averaged 56 years old. We measured the distances A: from the anterior end of the MWP at the level of vocal cord to the aryepiglottic fold; and B: from the anterior end of the MWP to the RLN. RESULTS: For male cadavers, distance A averaged 22.0 mm (range, 21.1-23.0 mm) and among female cadavers, it averaged 16.5 mm (range, 15.7-17.0 mm). Distance B, among male cadavers, averaged 16.0 mm (range, 15.6-16.5 mm), and as for female cadavers, it averaged 12.7 mm (range, 12.0-13.4 mm). CONCLUSIONS: This study provides surgical anatomy concept, which assists in the selection of a FLPS on early stage hypopharyngeal cancer at least. We think that an external approach FLPS may still have a role in the treatment of advanced hypopharyngeal cancer with difficult direct laryngoscope introduction if highly selection is performed.

關鍵字

functional laryngeal preservation surgery ； hypopharyngeal cancer ； recurrent laryngeal nerve ； thyroarytenoid muscle ； medial wall of pyriform sinus

並列摘要

背景：針對梨狀竇內側壁的下咽癌患者，能否採行開放性喉部功能保留手術通常是難以決定，進而限制此種手術方式的廣泛利用。對於經過同步放射及化學治療仍失敗的下咽癌病患，經口喉顯微雷射手術常常由於無法架設直接式喉鏡，而失去達成拯救治療的目的。本篇研究在於闡明梨狀竇內側壁與甲杓肌、喉返神經的解剖關係，進而幫助術前評估，在不違反手術完整清除惡性腫瘤的前提下，能否執行喉部功能保留手術。方法：本研究利用10具人類大體(5名男性5名女性)，平均56歲。量測長度A：在聲帶高度，梨狀竇內側壁的最前緣到杓會厭皺襞；長度B：梨狀竇內側壁的最前緣到喉返神經。結果：男性大體長度A平均22.0 mm (範圍，21.1-23.0 mm)，女性平均16.5 mm (範圍，15.7-17.0mm)。長度B，男性平均16.0 mm (範圍，15.6-16.5 mm)，女性平均12.7 mm (範圍，12.0-13.4 mm)。結論：本篇研究提供手術中解剖關係的結構藍圖，至少幫助在早期下咽癌病患能否進行喉部功能保留手術的篩選。至於晚期下咽癌的病患，在高度篩選合適病患下，我們認為開放性喉部功能保留手術仍有其角色，特別是針對直接式喉鏡難以架設的病患。

並列關鍵字

functional laryngeal preservation surgery ； hypopharyngeal cancer ； recurrent laryngeal nerve ； thyroarytenoid muscle ； medial wall of pyriform sinus（功能性喉部保留手術；下咽癌；喉返神經；甲杓肌；梨狀竇內側壁）

國際替代計量

The Cadaveric Study in the Hypopharyngeal Anatomy Framework to Assist in the Functional Laryngeal Surgery and Its Clinical Application

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