Near-total laryngectomy: An alternative RLN banking procedure

Objectives: Laryngeal transplantation may become feasible in the next several years. A functional transplant will require separate reinnervation by nerves that are activated synchronously with laryngeal adductor and abductor functions, ideally by branches of the original recurrent laryngeal nerve. This report reviews the potential to preserve these nerve branches by use of the near-total, rather than total, laryngectomy procedure. Study Design: Case series Methods: A chart review was performed of patients for whom a near-total laryngectomy (NTL) was selected with the specific purpose of preserving intrinsic laryngeal muscles innervated by their native motor nerves. Anatomic features of the tumors that make this option available were delineated. Results: Three patients underwent NTL as treatment for malignancy involving the larynx. Each patient was relatively young and expressed an interest in pursuing a laryngeal transplant at a future date if such a procedure were offered. In each case the NTL was successful at controlling the tumor, and the patient was left with aspiration-free swallow and prosthesis-free alaryngeal voice. Ultrasound examination demonstrated persistent bidirectional movement of the remaining cricoarytenoid joint. Conclusions: The NTL procedure may be the ideal method for recurrent laryngeal nerve "banking" for possible future use in laryngeal transplantation. It preserves the original laryngeal neuromuscular units for both adduction and abduction, as will be required for a functional transplant. This procedure should be considered in all younger patients that require total laryngectomy.