[The inferior laryngeal nerve: anatomical and surgical considerations about 60 thyroidectomy]. / Le nerf laryngé inférieur: considérations anatomiques et chirurgicales à propos de 60 thyroïdectomies.

Thyroid surgery requires a thorough knowledge of cervical anatomy and anatomical variations, in particular of the lower laryngeal nerve, in order to avoid iatrogenic lesions. The objective of our study was to analyze the relationships of the lower laryngeal nerve, the existence of branches of nerve division and a subjective appreciation of the size of the nerve. This is a prospective study of 1 year including 60 patients who underwent thyroidectomy. Sixty patients underwent surgery on the thyroid gland between February 2014 and January 2015 by the same principal operator (10 men and 50 women). The average age of our patients was 51 years. For men were performed 6 total thyroidectomies, 2 left lobo-isthmectomies and 2 right lobo-isthmectomies. For women were performed 33 total thyroidectomies, 8 left lobo-isthmectomies and 9 right lobo-isthmectomies. On the right, the nerve was superficial relative to the artery in 71.6% of cases; it was divided in 33.3% of cases and was abnormally thin in 16.6% of cases. On the left, the nerve was deep in relation to the artery in 83.3% of cases; it was divided in 15% of cases and was abnormally thin in 11.6% of cases. Knowledge of the anatomical variations of the lower laryngeal nerve is essential in thyroid surgery, the risk is particularly important on the right side given the sometimes very small caliber and the existence of branches of division more frequent than on the left side.

[Supracricoid partial laryngectomy (SCPL) with either cricohyoidoepiglottopexy (CHEP): our experience with 16 cases]. / Laryngectomies partielles supra-cricoïdiennes avec reconstruction par CHEP: notre expérience sur 16 cas.

Partial laryngectomy with either cricohyoidoepiglottopexy (CHEP) are mainly used to treat glottic cancers becuse they ensure a satisfactory preservation of physiological functions and satisfactory local carcinologic control. Our study aimed to analyze the functional and carcinologic results of this surgical technique. We conducted a retrospective study of patients undergoing partial laryngectomy with either cricohyoidoepiglottopexy in our Hospital between 2011 and 2014. We analyzed the epidemiological data, the surgical peculiarities, the functional outcomes and the carcinologic control of the disease. A total of 16 patients were included in this study. All our patients had T1 or T2 glottis squamous cell carcinoma. Functional outcomes were generally simple, especially in cases where the preservation of the 2 cricoarytenoid units was possible (75% of cases). However post-operative complications were reported in 31.25%. Carcinologic control was satisfactory, only one patient experienced local recurrence. Partial laryngectomy with either cricohyoidoepiglottopexy (CHEP) is a safe surgery preserving physiological functions and ensuring satisfactory quality of life. It also allows for good carcinologic control (it is subject of course to compliance with surgical indications).

Intramedullary spinal cord metastasis from laryngeal carcinoma: case report and review of literature.

Laryngeal cancer metastases are relatively rare and mainly affect the lung. The medullary localization remains exceptional. We report the case of a patient followed for operated laryngeal cancer and whose oncologic control revealed a medullary localization. A patient followed for squamous cell carcinoma of the larynx, treated in 2010 by a partial surgery whose endoscopic control at 5 years revealed the presence of right arytenoid edema without suspicious lesions, multiple biopsies were made and which returned negative. A month later, the patient presented a rebel cervical spine pain and a feeling of heaviness of the upper limbs, for which a radiological assessment was done finally objectifying a right hypopharyngeal process and a suspicious right internal jugular lymphadenopathy (biopsy confirmed the squamous type), as well as an intramedullary metastasis. This case is an illustration of an exceptional evolution of this type of cancer and a are metastatic localization difficult to highlight, which leads us to ask the question on the need of simultaneous and systematic radiological and endoscopic control treatment for operated laryngeal cancer.