Imaging Diagnosis Of The Recurring Laryngeal Carcinoma With Surgical Treatment

Background: The post-operated patients of laryngeal carcinomas have potential dangers of recurrence. Therefore,it is important how to discovery the recurrent tumour promptly and early. During the following-up of patients after partial and total laryngectomies, it may be found the recurrent tumour local on surface of membrana mucosa combining indirect laryngoscope with laryngofiberscopy. However, as a result, recurrent disease or residual neoplastic tissue often difficult to be detected particularly when there is a submucosal spread. The imaging, especially enhancement CT assumes a role in recurrent disease on the detection of submucosal lesions,which can display the location,boundary and relationship with peripheral vessels and nerve . So it may guide the postoperative clinical treatment. Enhancement CT exami- nation can offer full of diagnositic evidence of regional recurrence,neck recurrence even distant metastasis. The normal imaging of anatomy identifications will occur some extent of modifies after laryngectomies,so we understanding the normal postoperative patterns after conservative and radical surgery is essential to differentiate posttreatment changes from recurrences and to assess the submucosal extent of recurrent disease. Furthermore, the knowledge of particular variations of the surgical procedure is effective for the proper evaluation of postoperative findings in many cases. For this reason,this article summarize the imaging changes in several typical postoperative alterations and recurrent tumour,which expected to offer a few references to E.N.T doctors in diagnose and treatment .Objective : The purpose of this study was to analyze the imaging appearance(major in CT) of the recurring laryngeal carcinoma with surgical treatment,and then expected to guide the postoperative clinical treatment of laryngeal carcinoma patients。Method: The imaging features in 33 patients (major in CT) of the recurring laryngeal carcinoma after partial and total laryngectomies ,which obtained from the Department of Head and Neck Surgery Cancer Hospital (Institute), Chinese Academyof Medical Sciences and the Department of E.N.T Affiliated First Hospital DL Medical University from 2005 to 2006.the recurrent tumour consist of regional recurrence,neck recurrence and distant metastasis , confirmed by laryngoscopy , biopsy or surgery , were retrospectively analyzed.Result:of the 33 recurrent tumour, primarily squamous cell carcinoma (SCC) of the larynx ,glottic carcinoma(n=21), supraglottic carcinoma(n=11), hypolarynx carcinoma(n=1), regional recurrence (n=10),neck recurrence(n=10) regional and nodal recurrence (n=10),distant metastasis(n=1)。The dierffent postoperative imaging appearances were carefully analyzed among them.Within the recurrent tumour, enhancement CT shows recurrent tumour soft tissue mass,thickening,the center may have irregular low density zone of necrosis,its peripheral structure often compressed or invaded. CT can define the borderline of mass.of the neck recurrence, it can judge the nodal increment or not exactly.In the total 21 regions of cervical lymph node had nodal metastases ,of which ,16 regions can be diagnosed by CT when diameter≥10mm or 15mm as size criterion is used.Enhanceing rim ,central necrosis are reliable signs as diagnosing criterion is used ,too.Of the 33 ,one case occurs pulmonary metastasis confired by pathology.Conclusion :Period imaging following-up is important to the postoperative patients of Laryngeal Carcinomas . Enhancement CT is the basic imaging modality to assess those patients recur or not .The accuracy of CT is superior to phsicial palpation in evaluation cervical lymph node metastases.Otorhinolaryngologist should know not only the CT manifestation of the normal partial and total laryngectomies but also the recurrent tumour. Only that can we early discovery and treatment , especially to those easy recur cases . It is more possible to develop individual treatment, approach better prognosis, give prolongation of life, improve living quality.