In recent years, our hospital adopted vertical laterofrontal subtotal laryngectomy (VLFSL) and its expansion surgery to treat 60 cases of vocal hilar laryngeal carcinoma, which are reported as follows. I. Materials and methods 1. Clinical data: 60 cases of VLFSL and its expansion surgery were all vocal hilar laryngeal squamous cell carcinoma; age was 36—72 years, mean was 57,2 years. According to the revised staging and classification criteria of 1997 UICC, there were 20 cases of T2NOM0, 28 cases of T3NOM0, 5 cases of T4N0M0, 3 cases of T3N2M0, 1 case of T4N1M0, 1 case of T4N2M0, and 2 cases of recurrent carcinoma. 2. Surgical method: Tracheotomy and intubation with general anesthesia were performed first. The cricothyrotomy approach was used to enter the laryngeal cavity, and the thyroid cartilage plate and vocal cord were cut longitudinally at the appropriate part of the hemilarynx on the side with milder lesions to further expand the exposure field and observe the lesion area. Depending on the lesion, the anterior 2/3 or 4/5 of the thyroid cartilage plate of the affected hemilarynx, all the vocal and ventricular bands and the paraventricular space and the arytenoid cartilage are removed, and the anterior 1/3 or 1/2 of the thyroid cartilage plate of the contralateral hemilarynx, the anterior 1/3 of the vocal and ventricular bands or only the complete arytenoid cartilage is preserved as needed. After checking that the cut edge is adequate, the laryngeal cavity is repaired and reconstructed in various ways, such as inferior displacement of the epiglottis, myofascial flap of the anterior cervical muscle alone or in combination with myofascial flap of the sternocleidomastoid muscle, clothed flap of the thyroid cartilage of the strap muscle, and myofascial flap of the sternocleidomastoid muscle with a single or double tip, depending on the defect. The new laryngeal cavity mostly requires the placement of dilators. Expanded VLFSL is a procedure in which the laryngeal external structures such as the affected pyriform fossa, thyroid gland or part of the tracheal ring are expanded in addition to the above resection. In our group, there were 2 cases with extended resection of the suspected thyroid gland on the affected side; 1 case each with extended resection of the affected pear fossa, affected thyroid gland and pear fossa, and part of the tracheal ring. The method of laryngeal revision was basically the same as that of VLFSL, and one case with more laryngeal tissues resected used the residual larynx, trachea and pharyngeal mucosal flap to make the articulatory tube for revision. According to the condition, 15 patients underwent unilateral or bilateral neck contouring at the same time, and 42 patients underwent adjuvant radiotherapy (42 Gy-50 Gy) and 3 adjuvant chemotherapy (cisplatin + pinyamycin + methotrexate) after surgery. 3.Follow-up: The follow-up was carried out by letter, outpatient follow-up and telephone follow-up, and the follow-up rate was 95%, and 3 cases were lost. 4.Statistical processing: SPSS 10,0 software was applied for data processing. The survival rate was calculated by applying the life table method. The survival rates of 60 patients with VLFSL and its extended surgery at 3, 5 and 10 years were calculated by the life table method, and were 100, 0%, 94, 74% and 52, 63% for stage II and 89, 47%, 75, 0% and 61, 09% for stages III and IV. There were 6 cases of postoperative recurrence or metastasis, with a recurrence and metastasis rate of 10,0%. There were 14 deaths, among which 6 cases died of tumor recurrence and metastasis 5 months to 5 years after surgery, and 8 cases died of other diseases and accidents. The extubation rate of this group was 71,7% (43/60), and the average extubation time was 7,8 months; all patients basically recovered normal swallowing function after training; 53 cases had basically normal pronunciation, which did not affect language communication, and only 2 cases had severe hoarseness of pronunciation, but could still communicate through close whispering. There was no death in this group during the perioperative period, and the overall complication rate was 11,7% (7/60), including 4 cases of incisional infection, which were cured by changing medication; 3 cases of skin redness and swelling of the neck, all of which were patients with dilators placed in the laryngeal cavity, which were cured after early removal of dilators and strengthening of medication. III. Discussion In this group of VLFSL surgery, because of the attention to protect the arytenoid cartilage to preserve the side of the laryngeal recurrent nerve, rectification of the affected side of the “new vocal cord” posterior end are fixed in the original arytenoid cartilage location, postoperative hair “clothes” sound when relying on the healthy side of the arytenoid cartilage inward closure of the new vocal hatch to avoid postoperative cause misaspiration, choking and cough, to obtain a better Swallowing protection function. Most of the patients in this group were treated with different degrees of inferior displacement of the epiglottis and the placement of dilators in the new laryngeal cavity. The lowering of the epiglottis can increase the size of the new laryngeal cavity to varying degrees, and the higher extubation rate in this group was 71 and 67%, which was obviously related to the lowering of the epiglottis. This procedure has strict surgical indications and requires high surgical skills. If properly mastered, it can improve the quality of life of patients with intermediate and advanced laryngeal cancer without decreasing the long-term survival rate.