الفهرس 
Anatomy and function of the
Cuneiform and Corniculate cartilagesOnly 14 pages are availabe for public view
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Abstract
Laryngeal carcinoma is one of the common
malignancies of the head and neck. Incidence is higher in
males than females, and it is more affecting patients in 60 to
70 years old. More than 90% of laryngeal cancer is squamous
cell carcinoma (SCC), and is directly linked to smoking and
excessive alcohol use.
Total laryngectomy continues to play a major role in
the treatment of advanced laryngeal cancer or for
recurrent/persistent disease after failed organ preservation
attempts.
Laryngeal cancer patients are a great challenge and
they need meticulous evaluation preoperative and special
measures intraoperative and of course close observation and
management postoperative. The general condition of the
patients is one of the most important points during the
management. Those patients mostly are elderly smokers with
many associated comorbidities such as ischemic heart
diseases, chronic obstructive pulmonary diseases, diabetes
mellitus, impairment of renal and hepatic functions,
nutritional and psychological problems and notably their
preoperative treatment by radiotherapy and chemotherapy
with their associated undesired side effects. All of this
demands special consideration and perioperative
management.
Patient‟s history, physical examination, CT scan or
MRI findings, and ENT surgeons‟ evaluation by indirect
laryngoscopy or fiberoptic endoscopy are important before
the anesthesiologist‟s intervention. Airway management may be the major dilemma in
these patients. Establishing, maintaining and protecting an
airway in the face of abnormal anatomy due tumor and
simultaneous surgical intervention can be challenging.
All airway techniques need back-up plans. Adequate
assessment to identify the site and level of obstruction, in
particular with nasendoscopy, CT and MRI imaging, is
useful in guiding the initial airway plan.
Awake fibreoptic intubation, inhalational induction
and direct tracheal access techniques, all in fact have their
limitations. No plan is always successful but several back-up
plans, good communication within the team, experience,
training, adaptability and skill will all help determine the
outcome.