Limitations of supraglottic laryngectomy and conservative neck dissection.

Limitations of supraglottic laryngectomy may arise from either the primary location, or secondary spread of the tumor in the vestibule. When a growth reaches the epilarynx a modified supraglottic laryngectomy or a more radical operation must be envisaged. Other limitations include poor bronchopulmonary condition, age of the patient, and previous radiotherapy. All these conditions may jeopardize healing and/or, even more important, functional rehabilitation. New hands to this surgery should know its limitations and should be warned against its risks. On the other hand no limitations exist to conservation neck dissection, except fixed nodes or lymph node metastases following radiation or earlier surgery. The conservative technique is as radical as the traditional technique, but respects essential structures and thus widens instead of limiting the indications for elective bilateral neck dissection.