Procedure

• paint a vertical line of ink along one side of the larynx from epiglottis to tracheal limit to aid orientation and reconstruction after slicing.

• open the larynx vertically from behind with scissors and identify site of tumour.

• ink only the critical resection margins. This depends on the location and spread of the tumour, e.g., base of tongue and perihyoid soft tissues for anterior supraglottic lesions, lateral pharyngeal wall for lateral supraglottic and pyriform fossa tumours, postcricoid region for large glottic or postcricoid tumours, lateral perithyroid region for subglottic tumours.

• dissect off the hyoid bone, strap muscles, thyroid, neck dissection, etc. Look out for extrala-ryngeal spread of tumour. Supraglottic tumours often spread out of the larynx via the thyrohyoid membrane and subglottic tumours via the cricothyroid membrane. Tumour will permeate directly through ossified cartilages more readily than through cartilage that is not ossified.

• cut the larynx into 4 mm-thick slices in the coronal plane (i.e., in the plane of the vocal cords) to provide "rings" of tissue, working from the lowermost aspect to the base of the epiglottis. This is easiest with a band saw or other heavy-duty slicing device.

• slice the remaining supraglottic portion parasagitally with a knife to define precisely the upper aspect of supraglottic lesions.

• measurements:

- length of the larynx from superiorly to the inferior border of the cricoid (cm).

- dimensions (cm) of mucosal defects and other specimens.

maximum depth from reconstructed mucosal surface (cm). distances to closest mucosal and deep surgical margins (cm). mucosal abnormalities.

Description

• other plaque-like/ulcerated/fungating: usual type SCC. warty: well-differentiated SCC, verrucous carcinoma. polypoid: spindle cell SCC. white/thickened: in-situ lesions.

confined to larynx or spread through/between cartilages. tracheostomy, neck dissection, thyroid gland.

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