Open Partial Laryngectomies: History of Laryngeal Cancer Surgery

Abstract

Historically, surgery was the first-choice therapy for early, intermediate and advanced laryngeal squamous cell carcinoma (LSCC). Partial laryngeal surgery has evolved in recent decades and was influenced by many historic events and the development of new technologies. Partial laryngectomies may be performed by open, endoscopic or transoral robotic approaches. In this historic paper, we describe the evolution of open partial laryngectomy techniques, indications and surgical outcomes. Since the first partial laryngectomy in 1788, many U.S., U.K. and European surgeons, including Henry Sands, Jacob da Silva Solis-Cohen and Theodor Billroth, performed this surgical procedure under local anesthesia for tuberculosis, cancer or syphilis. Partial laryngectomy gained reputation in the medical community in 1888 due to the laryngeal cancer and death of the prince of Prussia, Frederick III. Frederick III's death represented the turning point in the history of partial laryngectomies, calling attention to the importance of semiotics, biopsy and early diagnosis in laryngeal cancers. Hemi-laryngectomy was indicated/proposed for lateral laryngeal tumors, while thyrotomy was indicated for cancers of the middle part of the vocal fold. The second landmark in the history of partial laryngectomies was the discovery of cocaine, novocaine and adrenaline and the related development of local anesthetic techniques, which, together with the epidemiological and hygienic advances of the 19th century, allowed for better perioperative outcomes. General anesthesia was introduced in the second part of the 20th century and further improved the surgical outcomes. The diagnosis of laryngeal cancer was improved with the development of X-rays and direct laryngoscopies. The 20th century was characterized by the development and improvement of vertical partial laryngectomy procedures and the development of horizontal partial laryngectomies for both supraglottic and glottic regions. The history and the evolution of these techniques are discussed in the present historical paper.

Keywords: cancer; head neck; history; laryngeal; larynx; otolaryngology; partial laryngectomy; surgery.

Figure 1

Killian laryngoscopy technique. This picture shows the technique of direct laryngoscopy developed by Killian.

Figure 2

Fronto-lateral laryngectomy. Monobloc resection, removing a vertical fragment of the thyroid cartilage, of the entire vocal cord, of the anterior commissure and of the anterior part of the contralateral vocal cord.

Figure 3

European Laryngological Society Classification of Open Partial Laryngectomies. Authors received the authorization of Pr. Marc Remacle to re-use the picture [4].

Figure 4

Supracricoid laryngectomy with crico-hyoido-epiglottopexy. Resection of the entire thyroid cartilage and both vocal folds with preservation of at least one arytenoid cartilage. Reconstruction: the closing of the larynx is carried out by an impaction between the cricoid cartilage, the epiglottis, the hyoid bone and the base of the tongue called a “crico-hyoido-epiglottopexy”.