Larenks Cerrahisi ve Boyuna Yaklaşım
Özet
Larenks cerrahisi ve boyun diseksiyonu yaklaşımı, 19. yüzyıldan bu yana gelişim gösteren dinamik bir alandır. Larenks cerrahileri; fonocerrahi, vokal kord ve larengeal çerçeve cerrahilerini kapsayan endolarengeal yöntemler ile parsiyel ve total larenjektomileri içeren geleneksel açık cerrahi yaklaşımlar olarak iki ana başlıkta incelenir. Günümüzde transoral robotik cerrahi (TORC) gibi organ koruyucu, minimal invaziv yöntemler giderek yaygınlaşmaktadır. Glottik ve supraglottik malignitelerde tedavi seçimi tümörün evresine, lokalizasyonuna, yayılımına ve hastanın fonskiyonel kapasitesine göre belirlenir. Bölgesel metastazları önlemede kritik öneme sahip boyun diseksiyonları ise radikal, modifiye radikal ve selektif tiplerde uygulanır. Glottik tümörlerde okült metastaz riski düşükken, supraglottik tümörlerde boyun metastazı daha sık görülür ve sağkalımı doğrudan etkiler. Gelişen teknolojiye rağmen, transoral cerrahinin uygulanamadığı anatomik kısıtlamalarda açık cerrahiler geçerliliğini korumaktadır.
Laryngeal surgery and neck dissection approach is a dynamic field evolving since the 19th century. Laryngeal surgeries are examined under two main headings: endolaryngeal methods covering phonosurgery, vocal cord, and laryngeal framework surgeries, and traditional open surgical approaches including partial and total laryngectomies. Today, organ-preserving and minimally invasive methods like transoral robotic surgery (TORS) are becoming increasingly widespread. Treatment selection in glottic and supraglottic malignancies is determined by tumor stage, location, extension, and the patient's functional capacity. Neck dissections, which are critical in preventing regional metastases, are performed in radical, modified radical, and selective types. While the risk of occult metastasis is low in glottic tumors, neck metastasis is more common in supraglottic tumors and directly affects survival. Despite advancing technology, open surgeries maintain their validity in anatomical limitations where transoral surgery cannot be applied.
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