Treatment of the patient with upper airway obstruction caused by cancer of the larynx

Abstract

The treatment of a patient with imminent airway obstruction caused by a malignant tumor of the larynx is an uncommon clinical problem. These cases need to be evaluated, diagnosed, and managed with care, skill, speed, and above all, appropriateness of intervention. Three methods are available to control the airway: tracheostomy, emergency laryngectomy, and controlled tracheal intubation with or without tumor debulking. Two groups of patients had their airways managed either by tracheostomy and delayed elective surgery or by emergency laryngectomy. There was no survival advantage between the groups, and no increased risk of stomal recurrence was demonstrated. If time permits, the patient is considered suitable, and adequate anesthetic and surgical instrumentation is available, it is currently recommended that the obstructing laryngeal tumor be debulked by cold-steel or, preferably, CO2 laser and that the emergency situation be stabilized and the definitive treatment of the patient be converted to an elective procedure without the need to create a tracheostomy.