The patient with obstructing laryngeal carcinoma who is tracheostomized for over 48 hours has a good chance of developing peristomal recurrence. The concept of emergency laryngectomy has arisen in an attempt to decrease the incidence of peristomal disease. The patient with toally obstructing carcinoma is tracheostomized and subglottic extension is determined with air contrast laryngography. A direct laryngoscopy, biopsy, and frozen section is performed and if the biopsy is positive a laryngectomy and neck dissection, if indicated, is performed in a single setting. For the partially obstructed patient, subglottic extension is first determined with air contrast laryngography and the rest of the procedures are done in one setting. Total obstruction sometimes results from laryngogram, barium swallow, and endoscopy. These patients are managed like the totally obstructed ones.
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Baluyot et al. (1971) studied this question.