Difficult indications for partial laryngectomy.

Difficult indications for certain partial laryngectomies are presented. Anatomically, the difficulties stem from the thyroid cartilage and from the paraglottic space in which invasion (difficult to determine) is contradictory for partial surgery. The principal objective is the cure of the laryngeal cancer all in maintaining laryngeal function. The surgeon must conserve a 'minimal' arytenoid unit' (the whole formed by the pharyngoepiglottic fold, the aryepiglottic fold, the arytenoid and the corresponding cord). Other difficulties not carcinogenic are found: physical conditions, social and professional situation, and preexisting local problems (associated laryngocel or previous vocal palsy). Finally, carcinogenic difficulties can be seen: the situation of the tumor, the rapidity of its evolution, anatomopathologic type, presence of nodes and metastases and previous physiotherapy and chemotherapy.