CT appearance of the larynx after conservative and radical surgery for carcinomas

Abstract.

The purpose of this study was to evaluate the normal CT appearance of the larynx after conservative and radical surgery. Postoperative (conservative surgery n = 52, radical surgery n = 21) CT examinations of 73 patients suspected of local/regional recurrence (n = 53) or asymptomatic (n = 20) were retrospectively analysed. The CT findings of 45 patients negative at biopsy were utilised to assess the normal appearance after surgery. Changes in the laryngeal framework represented constant landmarks, whereas the variety of soft tissues resection often resulted in a more unpredictable appearance of the neolarynx. Considerable thickening of the mucosa covering the arytenoid cartilage(s) has been detected after horizontal supraglottic laryngectomy (40 %) or supracricoid laryngectomies (SL; 100 %). A “pseudocord” due to scar tissue appeared to be a constant finding following vertical haemilaryngectomy, frequently after SL. Dilation of a lateral recess of the hypopharynx was observed after SL. This “pharyngeal pouch” had considerable size and air or liquid content. The most frequent CT findings among 28 tumours recurrent after conservative or total surgery were a mass larger than 10 mm spreading beyond the larynx (63.1 %), thickening of anterior commissure (57.9 %), erosion of residual cartilages (16.9 %). Although CT detected one subclinical recurrence, its employment is justified only to assess the submucosal extent of the lesion. This requires a thorough knowledge of normal postoperative findings.