Laryngectomy Defect

General Considerations

• Normal appearance of larynx on frontal radiograph of the chest or neck demonstrates normal narrowing of the airway at the level of the larynx and a sharp shoulder representing the inferior aspect of the true cords and larynx (see below)

Frontal view of lower neck. Black arrows point to the normal "shoulder" seen
on most frontal radiographs of the neck where the airway narrows for the larynx. The trachea is marked by a letter"T."

• There are numerous surgical techniques for total or partial laryngectomies
  • For most of the last century, total laryngectomies were the preferred surgical choice
• Radiation and chemotherapy together is used by some without surgery for certain stages
• During the latter half of the 20^th century, partial laryngectomies that preserved the voice became more widespread
• Surgery can be followed by post-operative radiation therapy and chemotherapy
• Near-total laryngectomies aim to preserve speech while excising the tumor
• In total laryngectomies, the surgery involves
• Removal of the entire larynx, hyoid bone, and strap muscles en bloc
• The thyroid gland may also be removed with the larynx
• Cervical node dissection may be done for some stages of the disease

Imaging Findings

• Absence of normal narrowing of airway at level of larynx, is replaced by...
• Large, usually V-shaped air containing space in neck

Laryngectomy defect. On the conventional radiograph on the left, the white arrows point to a large lucent defect superimposed on the upper airway. On the left, the yellow arrow points to the absence of the larynx, thyroid gland.
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