Morphological reconstruction of the neoepiglottis after hyo-sub-glosso-epiglottectomy (anteriorly extended supraglottic laryngectomy)

Preservation of laryngeal function through reconstruction of the supraglottis and thyrohyoid membrane with a chimeric anterolateral thigh flap after supraglottic laryngectomy: A case report and literature review

Supraglottic laryngectomy offers a treatment option in laryngeal cancer confined to the supraglottis with the aim to preserve laryngeal functions. Current reconstruction modalities face the challenges of restoring swallow function and preventing chronic aspiration. In this report, we present for the first time a case in which the thyrohyoid membrane and supraglottis were reconstructed using a chimeric anterolateral thigh (ALT) flap. Horizontal supraglottic laryngectomy was performed in a 70-year-old male patient with recurrent supraglottic laryngeal cancer after primary radiotherapy. The chimeric ALT flap used for reconstruction measured 7 x 20 cm and was based on two perforators, allowing it to be divided in two parts. The larger deepithelialized fasciocutaneous paddle was used for the reconstruction of the supraglottic defect and the smaller skin paddle was utilized as monitor flap and for neck resurfacing. The chimeric ALT flap was anastomosed to the superior thyroid artery and to a branch of the internal jugular vein. The postoperative recovery was uneventful. Laryngeal functions, including an unimpaired voice, could be preserved. Six months postoperatively, the patient showed no signs of chronic aspiration or tumor recurrence. Using a chimeric ALT free flap for reconstruction after horizontal supraglottic laryngectomy may prevent chronic aspiration through restoration of larynx elevation, mobility, and thus airway protection during deglutition due to increased supraglottic bulk.

Larynx-preserving reconstruction after extended base of the tongue resection

BACKGROUND

As the base of the tongue (BOT) plays essential roles in speech and swallowing, surgical resection of BOT cancer is typically avoided. Moreover, standard reconstructive procedures for larynx-preserving BOT defects have not yet been established. We performed immediate flap reconstruction after wide resection of BOT cancer with laryngeal preservation. Herein, the functional and oncological results of our strategy were analysed.

METHODS

We retrospectively evaluated patients who underwent extended BOT resection (including the oral tongue, upper/lateral oropharyngeal wall, epiglottis and false vocal cord) with laryngeal preservation between April 2006 and April 2016. We classified defects involving the oral tongue or upper/lateral oropharyngeal wall as the lateral extension type and those involving the epiglottis or false vocal cord as the laryngeal extension type. Lateral extension-type defects were closed primarily and filled with a deepithelialised skin or muscle flap. Laryngeal extension-type defects were reconstructed using a bulky skin flap plus hyo-thyroid-pexy to create a neo-epiglottis. Postoperative functional and oncologic outcomes were assessed.

RESULTS

We enrolled 18 patients with extended BOT defects. Of them, 11 had a history of irradiation. The tracheal cannula was removed in all cases, although laryngeal extension defects were associated with a longer duration to removal. All patients achieved complete oral intake and retained intelligible speech, with preservation of laryngeal function. There was no local recurrence, and the 5-year overall survival was 88.9%.

CONCLUSIONS

Following wide BOT resection, reconstruction with laryngeal preservation is feasible even in cases involving irradiated tumours with laryngeal extension.