A 60-year-old man with a T2N0 glottic carcinoma (squamous cell, no subglottic extension) undergoes radiotherapy. He develops recurrence confined to the glottis 18 months later. The surgical option offering the best functional preservation is:

• A Total laryngectomy
• B Supraglottic laryngectomy
• C Near-total laryngectomy
• D Transoral laser microsurgery (CO2 laser cordectomy) ✓

Explanation

For selected recurrences after radiotherapy in early glottic carcinoma, transoral laser microsurgery (CO2 laser) can achieve adequate margins while preserving laryngeal function (voice and swallowing). Total laryngectomy is the salvage standard for larger recurrences but sacrifices the larynx. Supraglottic laryngectomy is for supraglottic tumors. Near-total laryngectomy still results in a permanent stoma. Laser salvage is appropriate for selected T1-T2 recurrences at specialized centers.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.