Discussion on the Management of Cervical Metastases from Laryngeal Carcinoma

Abstract

Section of Laryngology 481 punctured and vitreous had been lost. Mr. Hargrove found it difficult to remove the eye owing to the gross fracturing of the orbital floor. He repaired the lacerations of the lower lid and removed several small pieces of bone which were remnants of the orbital floor and then placed the remaining bones, namely the malar and the floor of the antrum and lateral side of the nose, into position. The skin edges were sewn together.He dealt with numerous middle face fractures in his area and had not had to use the complicated splints used by facio-maxillary units as he found that these fractures healed very quickly without deformity after bringing the fractured bones in apposition by an external approach. His Dental Surgeon colleague attended to the teeth, making sure that the patient's teeth were in correct apposition using the lower jaw. Radiologist's report (Dr. Humphrey Foy): Facial region.-There is extensive comminution of the right orbital floor, the right antrum, and the right ethmoidal region of the face. The right malar bone is extremely mobile, and is displaced downwards and rotated outwards, and resulting in a large gap at the fronto-malar suture.There is a step fracture visible on the floor of the left orbital near its junction with the lateral orbital wall.In addition, there is some fragmentation of the posterior edge of the hard palate. The nasal bones are intact. There is a large amount of haemorrhagic effusion in the ethmoidal malar region. and Radium Institute): Nowadays more and more attention is being paid to the secondary deposits in the cervical lymph nodes which may arise from carcinoma of the larynx.' I have always been interested in this subject because I have had more trouble with recurrence in the lymph nodes after laryngectomy than with local recurrence.For example, Fig. 1 shows a larynx which I removed two and a half years ago. The growth was fixed and involved the greater part of the vocal fold; the ventricle of the larynx was not involved and there was very little subglottic extension-the photograph rather exaggerates this. One year later a small lymph node became palpable deep to the sternomastoid on the same side. I treated this by a radical neck 1 I1 ' _ dissection. Microscopic examination showed that the node had been invaded by a squamous-cell carcinoma. It is now two and a half years after laryngectomy and one and a half years after the neck dissection and the patient is alive and well -but one cannot always count on such results.Another case with a similar primary growth on the vocal cord got a recurrence in the lymph nodes four months after laryngectomy. After a radical neck dissection nodes appeared on the opposite side of FIG. 1. Carcinoma of the right vocal cord.the neck and though these were treated in the same way the patient eventually died of his disease. In spite of these experiences, I believe it is exceptional to get secondary gland involvement in this type of case and I would like to make it quite clear that I do not advocate the so-called prophy...