Twenty years of experience with Marullo’s supraglottic laryngectomy

Abstract

We present a follow-up study of 142 patients on whom we performed supraglottic laryngectomy (SL) with an anterior subperichondral approach using Marullo’s technique, which was described in 1975. Between January 1976 and December 1992, 142 patients (age range, 35–73 years) with squamous cell carcinoma of the supraglottic larynx were treated with SL or extended SL (ESL) and ipsilateral or bilateral neck dissections with or without postoperative radiotherapy. All cases were staged according to the 1997 UICC TNM classification. Survival was defined by the Kaplan-Meyer method and showed an overall survival of 77% and a local control rate of 78%. Regarding functional rehabilitation, the mean nasogastric tube-removal time was 16 days (range, 10–39 days) for SL and 23 days (range, 11–¶102 days) for ESL. Voice quality was very satisfactory after SL, while the voice was often harsh or breathy after ESL with postoperative radiotherapy. The overall oncologic and functional results obtained with Marullo’s SL were very similar to those obtained with the classic Alonso’s operation and demonstrated that this technique makes it possible to reach “en bloc” supraglottic sites and the hyothyroepiglottic space. We consider the operation to be safe and simple to perform, provided the sub-perichondral plane is correctly identified. This approach allows the surgeon easily to reach the correct transverse level above the anterior commissure of the vocal cords. Inferiorly, the resection cuts through the floor of the ventricle and is considered to be the safe oncologic plane for pure supraglottic lesions. This technique has also been used successfully in extended resections to treat tumors involving the base of the tongue, pyriform sinus and one arytenoid.