Abstract
Objective: Although it is accepted that there are size differences between female and male larynges, criteria for conservation laryngeal surgery for glottic carcinoma have not specifically addressed this matter. A laryngeal cadaveric anatomic study was undertaken to determine if the current criteria for conservation laryngeal surgery for glottic carcinoma is uniformly applicable to the female larynx. The past several decades have seen an increase in tobacco use among women, accompanied by an increased incidence of laryngeal cancer, thus underlying the relevance of a study of this nature
Methods: Anterior midline measurements between key landmarks of the larynges of 10 female and seven male cadavers were carried out and assessed. These measurements included the following: (1) anterior commissure to inferior border of thyroid ala distance; (2) anterior commissure to superior border of cricoid cartilage distance; and (3) anterior commissure to inferior border of cricoid cartilage distance
Results: The mean anterior commissure to inferior border of thyroid ala distance was 8.3 mm (range, 6 to 10 mm) in females and 11.8 mm (range, 10 to 13 mm) in males. The mean anterior commissure to superior border of cricoid cartilage distance was 17.5 mm (range, 15 to 21 mm) in females and 21.4 mm (range, 18 to 25 mm) in males. The mean anterior commissure to inferior border of cricoid cartilage distance was 23.7 mm (range, 20 to 27 mm) in females and 30 mm (range 26 to 35 mm) in males
Conclusions: The female cadaveric larynges were, on average, smaller than those of the male counterparts studied with regard to all investigated parameters. Of specific interest was the difference in the mean anterior commissure to inferior border of thyroid ala distance between female and male specimens. Classic teaching indicates that conservation laryngeal surgery for glottic carcinoma with less than 10 mm of anterior subglottic spread is oncologically sound, because tumor would theorectically be contained within the thyroid ala. Our data suggest that use of conservation laryngeal techniques in some female patients having glottic carcinoma with less than 10 mm anterior subglottic spread may be contraindicated, because spread to the level of the cricothyroid membrane (and thus extralaryngeal access) can occur well within this distance
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