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Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

After oral cavity and pharyngeal cancer, laryngeal cancer is the third most common malignant tumor in the head and neck region. According to the current German S3 guideline on the diagnosis, treatment, and follow-up of laryngeal cancer, larynx-preserving surgical interventions are part of the standard treatment of this disease, even in advanced tumor stages. However, in order to achieve the desired function-preserving effect, an exact indication is of crucial importance. In this article, the most important larynx-preserving interventions and their indications but also the respective contraindications are presented, with the aim of illuminating the surgical treatment options up to just before total laryngectomy., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: By today's standard, the optimal treatment of every individual tumor patient is discussed and determined in an interdisciplinary tumor board. According to the new S3 guidelines, larger volume T3 laryngeal cancers which are no longer safely resectable with larynx-sparing surgery are ideal candidates for a larynx preservation approach using primary chemoradiation (pCRT). So far, no clear criteria have been defined under what circumstances primary radiotherapy alone (pRT) might be acceptable in case chemotherapy (CT) is prohibited or in what cases, even in T3, upfront total laryngectomy with risk-adapted adjuvant treatment (TL±a[C]RT) should be recommended., Method: The literature was searched for parameters chosen as criteria for an inclusion in the surgical rather than the conservative arm in non-randomized LP studies or which proved to be significant prognostic markers after conservative treatment. Development of a counselling tool for therapeutic decision making., Results: Significant prognostic markers were tumor volume (< 3.5 ccm/< 6 ccm vs. 6-12 ccm vs. > 12 ccm), presence and kind of vocal cord fixation (none vs. Succo I/II vs. Succo III/IV), extent of cartilage infiltration (none vs. minimal vs. multiple/gross), nodal status (N0‑1 vs. N2-3), and laryngeal dysfunction (pretreatment necessity of feeding tube or tracheostomy)., Conclusion: For T3 laryngeal cancers, pRT could be acceptable when the tumor volume is < 3.5 ccm for glottic and < 6 ccm for supraglottic tumors and there are no further risk factors. pCRT can be regarded as the standard for LP for tumors between 6 ccm and 12 ccm, vocal cord fixation Succo pattern I/II, only minimal cartilage infiltration and a high nodal burden. For tumor > 12 ccm, vocal cord fixation Succo pattern III/IV, gross or multiple cartilage infiltration or clinically relevant laryngeal dysfunction, upfront TL±a[C]RT should be considered., (© 2022. The Author(s).)

Could primary chemoradiotherapy (pCRT) possibly be viewed as an alternative standard therapy to upfront total laryngectomy (TL)? According to the new German S3 guideline, despite higher rates of local recurrence, there would be no survival disadvantage and salvage surgery would be a curative option. In several large database studies and case series, statistically significant survival disadvantages of more than 30% between pCRT and TL have been reported for T4 laryngeal cancer. According to the literature, the success rate of salvage TL for T4 laryngeal cancer is only about 25-50%. Larynx preservation (LP) studies which could qualify the recommendation of pCRT as an alternative standard therapy to TL in T4 carcinomas should 1) evaluate T4a cancers within the T4 category; 2) perform subgroup analysis of laryngeal and hypopharyngeal cancers; 3) be sufficiently highly powered; 4) provide long-term outcomes of at least 5 years; 5) with oncological and 6) functional outcomes (duration of the need for tracheostomy and/or feeding tube dependency; necessity and success of salvage laryngectomies). 7) Specification of the criteria of the respective T4 classification (invasion through the outer cortex of the cartilage, or infiltration of which extralaryngeal structures) and 8) evaluation of pretreatment laryngeal function (at least: tracheostomy, feeding tube dependency). Collection of all the aforementioned data of T4 patients treated with pCRT in a large prospective observational cohort study in German-speaking countries is suggested. In case of rejection of TL by T4 laryngeal cancer patients, differentiation between primary spontaneous reluctance and a definitive, carefully considered decision is important. This distinction should be achieved by sensitive discussions. Not only oncological but also functional outcome probabilities should be included in the overall decision-making process., (© 2022. The Author(s).)

Background: Recurrent and residual laryngeal cancer after organ-preserving radio- or radiochemotherapy is associated with a poor prognosis. Salvage surgery is the most important therapeutic option in these cases., Objective: The study assessed rates of recurrence and residual tumor as well as survival and complication rates after salvage laryngectomy at the authors' academic cancer center., Materials and Methods: A retrospective examination of all patients receiving laryngectomy between 2001 and 2019 due to tumor residuals or recurrence after primary radio- and radiochemotherapy was conducted., Results: A total of 33 salvage procedures were performed. Defect reconstruction was performed by free flap surgery in 30.3% (n = 10) and regional flap surgery in 15.2% (n = 5) . One patient received regional flap surgery and free flap surgery simultaneously. Overall survival after 1, 2, and 5 years was 68.7, 47.9, and 24.2%, and disease-free survival was 81.6, 47.8, and 24.2%, respectively, with 48.5% (n = 16) postoperative tumor recurrences overall. Disease-free survival was significantly shorter for tumor extension into or onto the hypopharynx (p = 0.041). Postoperatively, 72.7% of patients developed a pharyngocutaneous fistula, of which 24.2% required surgical treatment. The hospital stay was 28.0 ± 16.1 days., Conclusion: Salvage laryngectomy is associated with a high rate of treatable complications and high morbidity. Nevertheless, considering the advanced tumor stages treated, it allows for respectable oncological results., (© 2021. The Author(s).)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

After total laryngectomy, regaining ability to speech is a keystone in regards of life quality. Voice prostheses have been shown to be a sufficient tool for satisfying communication, although frequent replacements of prostheses are burdening certain patients. Therefore, a more accurate understanding of mechanisms of prosthetic leakage is urgently needed., Methods: We performed a retrospective analysis of 58 Patients after laryngectomy. Additionally, we analyzed pre- and post-therapeutic CT-scans of 22 Patients regarding pharyngeal stenosis., Results: In 40 Patients, at least one replacement of voice prosthesis was documented during observation period, median device life was 235 days. Patients treated with adjuvant radiotherapy (RT) showed a significantly longer device life than patients with adjuvant radio-chemotherapy (RCT, p = 0.002). Furthermore, patients suffering of gastroesophageal reflux disease (GERD) showed a significantly shortened device life (p = 0.04).17 patients (42.5 %) suffered of clinically relevant stenosis of the neopharynx, which was treated with dilatation in 14 patients (82 %) and did not affect prosthesis device life., Conclusion: GERD is a risk factor for shortened voice prosthesis' device life and therefore should be treated effectively after laryngectomy. Also, adjuvant RCT predisposes a shortened device life.Stenosis is observed frequently after laryngectomy but does not affect device life when effectively treated., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Tumors of the larynx can substantially impair vocal function, breathing and also swallowing. The primary goal of reconstructive surgical treatment of laryngeal tumors is to sufficiently resect the tumor while minimizing the effects of the treatment on the voice, breathing and swallowing. In general, primary reconstructions in primary laryngeal surgery have many advantages. The tissue at this point in time is soft because the scarring process has not yet been initiated. A better prerequisite for a sufficient glottic closure can also be expected through the immediate adjustment of the volume of the vocal folds; however, reconstructive treatment can also be carried out secondarily. Different methods of reconstructive surgery for laryngeal carcinoma are presented and discussed.

The Flex Robotic System (Medrobotics, Raynham, MA, USA) allows flexible transoral endoscopic resection of head and neck tumors. The current article presents functional and first oncologic experiences with flexible transoral robot-assisted surgery for resection of supraglottic laryngeal tumors. From July 2014 to February 2020, supraglottic cancers in 32 patients (T1 = 11, T2 = 20, T3 = 1) were resected using the Flex Robotic System in the authors' clinic. Within a prospective clinical study, the feasibility, complications, and oncologic results were assessed. Tumors could be exposed, visualized, and successfully resected in all patients. In difficult-to-reach anatomic regions such as the aryepiglottic fold or petiole, the system provided a very good surgical overview. No serious adverse events occurred. Overall survival and local tumor control after 2 years were 88 and 94%, respectively. In conclusion, supraglottic tumors in difficult-to-reach areas have been successfully resected using the Flex Robotic System, with excellent local tumor control.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Background: In recurrent hypopharyngeal/laryngeal squamous cell carcinoma after radiation salvage-laryngectomy (salvage-LE) represents the best curative treatment option. Pre-irradiation promotes development of pharyngocutaneous fistulas (pc-fistula). Transfer of unirradiated tissue to the surgical site reduces fistula rate. Frequently, a myocutaneous Pectoralis-major-flap (PMF) is applied. We describe a muscle sparing, myofascial PMF (ms-PMF) and its functional & aesthetic results., Methods: For the ms-PMF, the pectoralis major is exposed via two 8 cm long subclavicular & submammary horizontal incisions. The pectoral branch of the thoracoacromial artery, which represents the blood supply for the ms-PMF, is identified between the clavicular and sternocostal aspect of the muscle. A craniocaudal stripe of the pectoralis major is recovered and supraclaviculary transposed towards the pharynx. The clavicular and sternocostal part of the muscle remain untouched.The clear-margin resection rate (CMRR), mean overall survival (OS), complications, median length of hospital stay, & functional & aesthetic outcome were assessed., Results: In 25 patients, salvage-LE with ms-PMF was performed. The CMRR was 100 %, median OS 1.3 (follow-up 2.8) years, complications rate 16 % (4 complete lobe necroses, 3 pc-fistulas) and median inpatient stay 20 (11-78) days. Good functional outcome were observed: limitations of oral food intake occurred in 2-, limitations in voice rehabilitation in 3 patients. Wound healing disorders without lobe necrosis were not observed. The aesthetic results were appealing., Conclusion: The ms-PMF is a less invasive & safe procedure for fistula prophylaxis in salvage-LE with favorable functional & aesthetic results., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht.

Transoral laser microsurgery (TLM) for treatment of laryngeal cancer has reduced temporary tracheotomies, increased organ preservation rates, and improved functional results. Gold standard for laser-based transoral resection of laryngeal cancer is the application of CO 2 lasers. Oncologically safe radical resection and postoperative voice outcome must be weighed up individually. Angiolytic laser effects enable modification of the tumor micromilieu by targeted obliteration of microvessels and antagonization of angiogenesis with preservation of vibrating laryngeal tissue for good voice function. Introduction of the German S3 guideline on diagnosis, treatment, and follow-up of laryngeal cancer is a critical step towards national evidence-based standardization. Internationally, the evidence for treatment of laryngeal mucosal dysplasia and T1a cancer with angiolytic potassium titanyl phosphate (KTP) lasers is increasing. Angiolytic lasers are also used for juvenile papillomatosis and suspension microlaryngoscopy under general anesthesia or local anesthesia in selected patients.

Total laryngectomy provides a curative approach for patients with advanced laryngeal and hypopharyngeal cancer without distant metastasis. Especially in stage cT4a disease, laryngectomy is superior to primary radio(chemo)therapy in retrospective studies. Further relevant indications for the procedure are tumor-related laryngeal dysfunction such as dysphagia and aspiration, as well as cancer recurrence after primary radio(chemo)therapy. The surgical procedure is highly standardized, with an appropriate safety profile. The subsequent loss of voice must be compensated by voice rehabilitation (voice prosthesis, ructus). The current overview provides information about indications for laryngectomy, preoperative clinical diagnostics, the surgical procedure, complications, alternative treatment, rehabilitation, and prognosis. Total laryngectomy remains a standard procedure in modern head and neck oncology.

Elective neck dissection of the N0-neck is routinely performed during salvage laryngectomy (SLE) for recurrent cancer of the larynx or hypopharynx. The therapeutic benefit of additional neck dissection must be weighed against the risk of increased morbidity. In this retrospective analysis, we assessed oncologic parameters of patients who underwent SLE with concurrent bilateral neck dissection for recurrent laryngeal or hypopharyngeal cancer. We compared these data with patients who underwent primary laryngectomy (LE) with bilateral neck dissection for laryngeal and hypopharyngeal cancer.19 patients who had undergone SLE and 83 patients after LE were included in the analysis. The majority of patients had advanced stage tumors prior to LE or primary radiation therapy, as well as advanced stage recurrent tumors prior to SLE. Prior to SLE, 5 % of all patients (n = 1) had clinically pathologic lymph nodes, compared to 47 % (n = 39) prior to LE. 17 % (n = 14) of patients with LE and bilateral neck dissection had occult lymph node metastases, compared to 5 % (n = 1) of patients who underwent SLE with bilateral neck dissection. Overall, 55 % (n = 44) of patients who underwent LE had positive cervical lymph nodes, compared to 10 % (n = 2) of SLE patients. Lymph node yield was higher in patients with LE than in SLE-patients (37.3 vs. 18.7, p < 0.001). 5-year OS was 50 % after LE and 33 % after SLE. Cervical lymph node metastases are rare in patients who undergo SLE for recurrent cancers of the larynx of hypopharynx. However, occult metastases do occur. Therefore, since SLE is the final curative therapy, additional neck dissection should be taken into consideration., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Der Autor gibt an, dass kein Interessenkonflikt besteht.

Lipoinjections into the vocal folds are well established in otorhinolaryngology. Currently, lipofilling in patients with surgical defects after laser cordectomy is discussed. We describe a new device for liposuction and lipofilling for primary vocal fold reconstruction after laser cordectomy. A patient with a surgical defect after pT1a glottic cancer is presented. Primary lipoinjection after laser cordectomy was documented as a safe and easy method to reconstruct the surgical defect. No relevant complications have been observed., Competing Interests: Herr PD Dr. Frank Haubner erhielt Honorare für Vorträge sowie die Erstattung von Reisekosten von der Fa. Spiggle&Theis, (© Georg Thieme Verlag KG Stuttgart · New York.)

Total laryngectomy still is a standard procedure for the treatment of advanced laryngeal or hypopharyngeal carcinoma. The unavoidable loss of voice may lead to serious impairments in quality of life. The most common technique of voice restoration is the tracheal-esophageal puncture combined with the application of a voice prosthesis. Laryngeal reconstruction with a radial forearm flap represents a possible surgical method of voice restoration. This study is a mono-center retrospective analysis of patients receiving a so-called laryngoplasty after total laryngectomy between 2006 and 2015, focusing on long-term functional outcome and complications. 39 patients were included. Sufficient phonation was possible in 77 %, finger-free speaking was achieved in 62 %. Exclusion of irradiated patients revealed a rehabilitation rate of 91 %. The most common early complication was cervical hematoma in 15 %, whereas no loss of flap was assessed. Stenosis of the laryngoplasty was seen in 7 cases, mainly post-irradiation. The rate of successful voice restoration is equal in both, laryngoplasty and voice prosthesis patients. However, voice quality is better after surgical reconstruction. Complications induced by the voice prosthesis, which may be severe in some cases, were not seen in the study group. Furthermore, life-long support by an ENT specialist regarding voice prosthesis exchange is not necessary. Assuming correct choice of candidates, laryngoplasty is a sufficient method for voice restoration after laryngectomy., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Although microlaryngoscopy is an integral part of surgical routine of otorhinolaryngologists, there is no population-based data published on surgery rates and efficiency of microlaryngoscopy country-wide or nation-wide. All 616 patients who underwent microlaryngoscopy 2011 in one of the eight ENT departments in Thuringia were analyzed according to patients' characteristics, therapy, complications and follow-up. The majority of admissions were performed because of a benign disease (60%) of the larynx, and in 33% related to a malignant disease or suspicion of a malignant disease. When a benign disease was suspected, it was confirmed 98% of cases. When a malignant tumor was suspected, it was confirmed in 51% of cases, i. e. ruled out in 49% of cases. Transient laryngeal edema (22%) and bleeding needing revision surgery (1%) were the most frequent or serve observed postoperative sequelae. Teeth damage occurred only in 2 cases (0.2%). A recurrence of the primary disease was observed in 14%. Longer surgery time was an independent predictor for postoperative bleeding and for postoperative laryngeal edema (p=0.050 and p=0.013, respectively). Revision surgery (p<0.0001) and a final diagnosis of a malignant disease (p=0.017) were independent predictors for recurrence of the primary disease. The overall incidence of microlaryngoscopy was 22.98/100000 population. The highest incidence was seen for patients 50-59 years of age with 39.76/100000. Benign diseases were the most frequent indication with 19.33/100000. This population-based analysis is showing that microlaryngoscopy is performed effectively and with low postoperative risks in daily routine of otorhinolaryngologists., Competing Interests: Interessenkonflikt: Kein Interessenkonflikt angegeben., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: Analysis of pre-operative tracheostomy and circumjacent tumour free margins as risk factors in the development of stomal recurrent disease after (pharyngo)laryngectomy. Material and Methods: 124 patients after (pharyngo)laryngectomy were analyzed for disease related data and tumour samples were analyzed for tumour free margins. The overall cohort was divided into patients with/withour pre-operative tracheostomy. Results: 18 patients suffered from recurrent disease (10 stomal, 8 distant metastases). Advanced T-status, female gender, and sub-/glottic tumour manifestation resulted in a higher rate of prior tracheostomy. Pre-operative tracheostomy did not influence the development of stomal recurrency. R0 resection was achieved in 94% of our patients, with significant reduced tumour free margins in patients with stomal recurrency (p=0.002) Conclusion: Pre-operative tracheostomy did not influence the development of stomal recurrent disease. The clinical identification of ventral soft tissue infiltration should result in extensive surgical concepts., (© Georg Thieme Verlag KG Stuttgart · New York.)

Surgical treatment of benign vocal fold lesions can be indicated for clinical or functional reasons. The principles of phonosurgery have to be maintained in either case. The appropriate phonosurgical technique depends on the type of vocal fold lesion. Depending on the findings, phonosurgery aims to maintain or improve voice quality. The evaluation of clinical and functional results includes indirect laryngoscopy, videostroboscopy, and voice analysis.

Over the past 20 years, the therapeutic concepts for the treatment of head and neck cancer have evolved and non-surgical treatment strategies have gained in importance. However, despite improved organ preservation protocols and primary chemoradiation, tumor recurrence is still frequent. Under these conditions, salvage surgery if often the only remaining curative treatment option. Over the past 30 years, advancements in plastic-reconstructive surgery have broadened the surgical spectrum in the head and neck area, offering new treatment options for salvage surgery in recurrent cancer of the pharynx and larynx. Survival after salvage surgery mainly depends on the primary treatment modality as well as the localization and tumor stage at the time of initial diagnosis and local recurrence. For the reconstruction of defects after salvage surgery, pedicled flaps and microvascular free flaps may be utilized. The most frequently used flaps in these situations are the pectoralis major island- or the myocutaneous latissimus dorsi island flap. The radial forearm and the ALT-flap are potentially applicable free flaps. With the use of these flaps, vital tissue is transferred into the previously irradiated area, hereby allowing for reconstruction and functional preservation of the resected area and preventing complications such as fistulas. The expected morbidity and the likelihood of surgical success must be assessed thoroughly in every individual case prior to performing salvage surgery. This review aims to support decision making in these situations., (© Georg Thieme Verlag KG Stuttgart · New York.)

Surgical treatment of laryngeal cancer has been established for decades. In addition to total laryngectomy, which was first performed in 1873, a large number of organ preservation surgical techniques, like open partial laryngectomy, transoral laser microsurgery and transoral robotic surgery, have been developed. Studies on laryngeal cancer surgery are mainly retrospective case series and cohort studies. The evolution of chemoradiation protocols and their analysis in prospective randomized trials have led to an increasing acceptance of non-surgical treatment procedures. In addition to an improvement of prognosis, in recent years the preservation of function and maintenance of life quality after primary therapy of laryngeal cancer has increasingly become the focus of therapy planning. Significant late toxicity after chemoradiation has been identified as an important issue. This leads to a reassessment of surgical concepts and initiation of studies on laryngeal cancer surgery which was additionally stimulated by the advent of transoral robotic surgery in the U.S.. Improving the evidence base in laryngeal cancer surgery by successful establishment of surgical trials should be the future goal., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Transoral laser microsurgery (TLM) is the method of choice for partial laryngectomy in Germany. In advanced stages, chemoradiotherapy is increasingly indicated for organ preservation., Objective: This report considers the indications for and outcomes of supracricoid partial laryngectomy (SPL), also known as crico-hyoido-(epiglotto)-pexy, as an option for surgical organ preservation in moderately advanced laryngeal cancer (T3-T4a), in the well-defined gap between TLM and chemoradiotherapy protocols in Germany., Methods: Retrospective evaluation of functional and oncological outcomes of all SPLs conducted between 2008 and 2014. During this period, 17 SPLs with resection of rpT2 (n = 2), (r)pT3 (n = 11), and (r)pT4a (n = 4) were performed with resection of one arytenoid. Mean age was 58 years (range 47-75 years). In 5 patients, SPL was for a first or second local recurrence after TLM or open partial laryngectomy. Adjuvant radiotherapy was received by 7 patients staged pT4a or pN+., Results: Salvage laryngectomy with adjuvant radiotherapy was required by 2 patients. The remaining patients (n = 15) had a mean tumor-free follow-up of 4 years with a functional intact larynx: these patients can eat and drink, have a closed tracheotomy, and a good voice. After 3 years tumor-free follow-up with a functional intact larynx, 2 patients died due to cardiac comorbidity at the age of 76 years., Discussion: SPL is a rare but valuable option for surgical larynx preservation in stage pT3-4a laryngeal cancer.

Background: Fear of recurrence (FoR) is a common problem in cancer patients. However, it is quite unknown in which extent patients who underwent a PL have FoR. This pilot study examines the extent of FoR and coping strategies in cancer patients after PL as well as associations between FoR and medical, treatment-related, psychosocial and demographic parameters., Material and Methods: In a multicentre cross-sectional study, data was taken from 154 cancer patients after PL. Data was collected in personal interviews and with standardised questionnaires (e. g., PA-F; HADS; EORTC H&N-C35)., Results: The study participants had a low level of FoR (MW=6.67; SD=2.43) and a high level of coping strategies (MW=3.24; SD=0.83). FoR was higher in young patients (r=-0.265; p=0.002) and in users of medical rehabilitation programs (U=1 480; p=0.025). Patients who thought smoking (r=0.197; p=0.029) or/and inner conflicts (r=0.177; p=0.050) was/were the reason(s) for their cancer and who reported more swallowing problems, had a significantly higher level of FoR (r=0.496; p<0.001). There was a negative correlation between the extent of FoR and time passing by since the last surgery of the larynx (r=- 0.322; p<0.001)., Conclusions: Frequently occurring swallowing problems as well as internal causal attributions for the development of cancer as smoking increase the level of FoR. Since internal causal attributions may cause feelings of guilt, psycho-oncological treatment can be indicated for patients with higher levels of FoR. Furthermore, younger individuals and patients with more swallowing problems need more attention by physicians and therapists., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The salvage laryngectomy (SLE) is very often the only curative option in recurrent laryngeal or hypopharyngeal carcinomas. But the SLE is associated with an increased risk of complications such as the formation of salivary fistulas. To reduce the rate of fistulas a simultaneous elevation of the myofascial pectoralis major flap (PMML) is described. The aim of this study was to compare the SLE with and without the use of the PMML for prophylaxis of salivary fistulas., Patients and Method: 9 patients were included, suffering from a T4a larynx or hypopharynx carcinoma recurrence after RCT in the years 2012 and 2013 and subsequently treated by a SLE. An additional elevation of PMML was indicated due to the following criteria: end of RCT less than one year ago, tumor localization outside the glottis, infiltration of thyroid cartilage and prelaryngeal muscles. After PMML elevation the flap was sewed onto a primary closed pharynx., Results: 6 out of 9 patients (2/3) received an additional covering of the pharynx by the PMML during SLE. In no case a postoperative salivary fistula was seen. In the remaining 3 patients (1/3) the pharynx was primarily closed without an additional covering by the PMML. In this group of patients one postoperative salivary fistula was seen., Conclusion: Due to the simultaneous application of the PMML in the context of SLE the rate of postoperative salivary fistula could be effectively reduced in our own patients. The PMML is suitable due to its safe elevation technique, the missing secondary thoracal cutaneous defect, and a good modelling possibility in the recipient area., (© Georg Thieme Verlag KG Stuttgart · New York.)

The suprachoroidale partial laryngectomy (SCPL) can provide organ-preserving alternative to total laryngectomy in selected endolaryngeal malignancies. In a large case series Sperry et al. retrospectively analyzed the surgical and oncological outcome.

Transoral laser surgery has become a standard procedure in the treatment of benign and malignant neoplasms of the upper aerodigestive tract. As the laser cuts and coagulates simultaneously, intraoperative bleeding is reduced, thus improving visualization of the operative field. However, the specific risks for patients and personnel that are associated with this technique necessitate strict compliance with safety regulations and precautions. The safe anesthesiological and surgical management of such procedures requires explicit knowledge of the risks inherent to laser use, as well as close communication between surgeon and anesthesiologist throughout all operative and perioperative procedures. Although potentially fatal complications are rare, surgeon and anesthesiologist need to be aware of the dangers at all times and have exact knowledge of emergency measures. The use of suitable laser-resistant endotracheal tubes, total intravenous anesthesia and an optimized breathing gas mixture can contribute to minimize the occurrence of complications in otorhinolaryngology laser surgery.

Advanced laryngeal and hypopharyngeal carcinomas are associated with a poor prognosis and a pronounced loss of quality of life due to impairment of the swallowing and voice function. The fundamental therapeutic challenge is successful tumor control with concomitant rehabilitation of swallowing and voice functions. Further objectives are a low complications rate (fistula, aspiration) and prompt transfer to the adjuvant radio-oncologic therapy. With these factors in mind, the microvascular anastomosed jejunum speech siphon with a biventer rein has proven to be an effective method of reconstruction following extensive circular laryngopharyngeal resections. In this case report, a typical operative and postoperative course is presented, as are the functional results.

Pathologies in the larynx and trachea in the pediatric age can be characterized in 4 main groups: airway stenosis, acute infections, benign neoplasia and foreign body aspiration. In this review main diagnostic strategies and therapeutic options are presented. Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it's repair using an endoscopic approach. Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred. Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases. Tracheostomy is not a safe airway in early infancy, it's indication should be strict. Foreign body aspiration needs to be managed according to a clear algorhythm. Recurrent respiratory papillomatosis should be treated with emphasis on function preservation. The role of adjuvant medication remains unclear. Infectious diseases can be managed conservatively by a pediatrician in the majority of cases., (© Georg Thieme Verlag KG Stuttgart · New York.)

About 2/3 of the larynx carcinomas affect the vocal chords. The main risk factor is smoking. Carcinomas in this localisation often arise from leukoplakias with dysplasia. A typical symptom is dysphonia. Arrest of vibration in microlaryngostroboscopy is a hint that a carcinoma could be present. Transoral laser cordectomy or radiotherapy show equivalent oncological results and results in quality of voice in the treatment of vocal fold carcinoma (T1a). As lymph node and distant metastasis are very rare, follow-up can concentrate on microlaryngoscopy. In case of a suspicious area on the vocal fold, biopsy of the affected tissue is needed to plan correct treatment. The prognosis of the T1 vocal chord carcinoma is quite good with a 5-year survival rate of almost 100%., (© Georg Thieme Verlag KG Stuttgart · New York.)

The classic indications of TORS are still limited mostly to partial resections of the oropharynx, hypopharynx und supraglottic larnyx. In addition to these, there has been some promising applications towards broadening the limits of robotic assisted head and neck surgery and to perform a trans oral total laryngectomy (TORTL). Using the robotic assisted transoral approach for a total laryngectomy can reduce the risk of fistula formation after salvage laryngectomy effectively, avoiding a wide apron flap and with no plane dissected between the skin and the strap muscles. Trans Axillary Robotic Surgery, or TARS, offers similar advantages through an axillary access to the outer neck: this way, the skin incision will be placed outside of the future radiation field, if the latter is indicated. The transaxillary thyroidectomy is an important step in the learning curve of robotic assisted neck dissection and other TARS-procedures, and is seen as "the gateway to the neck". The present review article provides with a summary of the published literature of this novel approach to date, i. e., transoral robotic total laryngectomy and robotic assisted neck dissection. The fusion of these 2 adds up to the concept of Robotic Combo Surgery, resulting in the ultimate combination of scarless head and neck surgery for the primary as well as for the neck., (© Georg Thieme Verlag KG Stuttgart · New York.)

Malignant haematological diseases such as the highly malignant diffuse large B-cell lymphoma, the MALT-lymphoma and the extramedullary plasmocytoma are seldom located in the larynx. In this review, clinical symptoms, laryngoscopic findings, further diagnostics as well as therapy concepts are presented. Diagnosis is complicated and delayed due to the absence of classical pathognomic findings. Biopsy of the affected tissue can secure a correct diagnosis and malignant haematological disease can be ruled out., (© Georg Thieme Verlag KG Stuttgart · New York.)

Benign vocal fold lesions are grouped in lesions arising from the epithelium like papillomas, lesions affecting the Reinke's space (nodules, polyps, cysts, Reinkes's edema as a form of chronic laryngitis) and lesions affecting the arytenoid (granulomas). A multifactorial genesis is assumed. Main symptoms are dysphonia and hyperfunctional vocal behavior that might also be a cause of these lesions., (© Georg Thieme Verlag KG Stuttgart · New York.)