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SURGERY FOR LARYNGEAL CANCER Partial laryngectomy procedures

Surgery for laryngeal cancer is of several kinds. Small, localised tumours which have not become truly invasive (these are referred to as carcinomas in-situ) may be treated simply by local excision at microlaryngoscopy, or by laser excision. Tumours of one vocal cord may be treated by a vertical, partial laryngectomy in which the larynx is split externally and the affected cord is removed. Slightly larger growths may be treated by an extended, vertical, partial laryngectomy. Although these operations are used quite extensively as primary treatment in north America, British surgeons usually reserve them for well-localised tumours which recur after radiotherapy. This is quite an unusual occurrence and such operations are therefore rare in British practice. The results of primary treatment by partial laryngectomy for small tumours are as good as those of radiotherapy in terms of control of disease but far less satisfactory in terms of voice. Removing one vocal cord, even with an attempt to reconstruct the cord with use of a muscle flap, tends to produce a harsh and weak voice. It is because the results in terms of voice are so much better with radiotherapy that British laryngologists prefer primary radiation treatment for small tumours.