1. Tumour resection method
After the neck lymph node dissection was completed, the free cervical
sheath was pulled outward, the ipsilateral thyroid lobe was separated,
and the ipsilateral great horn of the hyoid bone was removed. The
inferior constrictor of the pharynx was cut off on the surface of the
thyroid cartilage plate, and the thyroid cartilage plate was obliquely
incised so that the thyroid cartilage plate was divided into two parts:
anterior 2/3 and posterior 1/3. The piriform sinus was gradually
separated from the larynx by pulling the posterior part of the thyroid
cartilage plate outward and removing the connective tissue along the
lateral surface of the thyroarytenoid muscle, and the paraglottic space
was easily exposed (Fig. 1).
For the carcinoma of the lateral wall of the piriform sinus, the thyroid
cartilage plate was pulled outward, and the ipsilateral piriform sinus
can be separated from the larynx through the paraglottic space approach.
The tumour was fully exposed and resected under direct vision, and all
the cutting edges were sent for frozen pathology until the negative
margin was obtained. For the carcinoma of the medial wall of the
piriform sinus, the lateral surface of the thyroarytenoid muscle was
fully skeletonised until the arytenoid cartilage appeared. Firstly, the
resection of the deep margin of the tumour was completed. Subsequently,
the tumour was removed under direct vision by entering the pharyngeal
cavity naturally through the free edge of the aryepiglottic fold or
through the posterior incision of the thyroid cartilage plate into the
pharyngeal cavity (critical surgical steps were shown in Fig. 2, (Such
as Video1).). If the paraglottic space was involved during the
operation, partial laryngectomy or total laryngectomy was performed
selectively.