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Double pyramid technique of transoral laser partial laryngectomy for radiorecurrent laryngeal cancer
  1. Rasads Misirovs1,
  2. Isabel Gartner2 and
  3. Jaiganesh Manickavasagam1,3
  1. 1 Department of Otorhinolaryngology, Ninewells Hospital, NHS Tayside, Dundee, UK
  2. 2 School of Medicine, University of Dundee, Dundee, UK
  3. 3 Tayside Medical Science Centre, University of Dundee, Dundee, UK
  1. Correspondence to Dr Rasads Misirovs, rasads.misirovs{at}


Management of recurrent head and neck cancer is challenging. Surgical treatments for residual or radiorecurrent laryngeal cancer include total laryngectomy, open partial laryngectomy and transoral laser microsurgery (TLM). TLM has been shown to achieve good oncological and functional outcomes in radiorecurrent laryngeal cancer. We describe a case of a patient with radiorecurrent T2 (rT2) with impaired vocal cord mobility laryngeal cancer who underwent transoral laser partial laryngectomy using our proposed double pyramid technique. It encompasses two steps: resection of the superior and inferior pyramids. Full resection is achieved by staying close to the thyroid and cricoid cartilages. In this technique, the dissection principle is to remove anterior commissure in two pyramid fashions without having to actually follow the tumour. This method is easy and simple to master. Two years postoperatively, the patient has no signs of recurrence and is able to use her voice and has full swallowing ability.

  • ear, nose and throat/otolaryngology
  • head and neck cancer
  • head and neck surgery
  • otolaryngology / ENT
  • surgical oncology

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  • Contributors RM: writing up case report and discussion section. IG: writing up case report. JM: guiding and supervising the case report and discussion sections.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at The case was presented as a poster at ENT Scotland meeting in November 2017.

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