Corniculate-cuneiform flap for reconstruction in the extended vertical partial laryngectomy

Platysma skin flap: Laryngeal repair material to produce phonatory flap vibrational wave

The platysma skin flap was used for laryngeal reconstruction after vertical partial laryngectomy to improve the postoperative voice quality of patients with T2 and T3 glottic laryngeal carcinoma. Sixty-nine patients with unilateral T2 and T3 glottic laryngeal carcinoma were included. Forty-six patients received vertical partial laryngectomy, and a platysma skin flap was used for laryngeal reconstruction. The other 23 patients underwent transoral laser microsurgery. Subjective and objective examinations were performed to evaluate laryngeal morphology after the surgery. Acceptable voice quality was achieved for 46 patients who underwent vertical partial laryngectomy. Flap vibrational waves occurred in 19 cases (41.3%). The platysma skin flap is an ideal tissue for the reconstruction of articulation structure in open surgery of T2 and T3 unilateral glottic laryngeal carcinoma.

Organ preservation surgery for laryngeal cancer

The principles of management of the laryngeal cancer have evolved over the recent past with emphasis on organ preservation. These developments have paralleled technological advancements as well as refinement in the surgical technique. The surgeons are able to maintain physiological functions of larynx namely speech, respiration and swallowing without compromising the loco-regional control of cancer in comparison to the more radical treatment modalities. A large number of organ preservation surgeries are available to the surgeon; however, careful assessment of the stage of the cancer and selection of the patient is paramount to a successful outcome. A comprehensive review of various organ preservation techniques in vogue for the management of laryngeal cancer is presented.

Laryngeal reconstruction by platysma myofascial flap after vertical partial laryngectomy

BACKGROUND

Many methods of glottic reconstruction have been described for patients undergoing vertical partial laryngectomy to reestablish the glottic integrity.

METHODS

Fifteen patients with T2 squamous cell carcinoma of the glottis were included in this prospective clinical trial. All patients were treated by vertical partial laryngectomy with laryngeal reconstruction by platysma myofascial flap. The surgical procedure and flap design were described. Vocal function was assessed by videolaryngostroboscopy and subjective and objective voice analysis before and after surgery.

RESULTS

Complete neoglottic closure and acceptable voice quality were obtained by platysma myofascial flap in all cases. No statistically significant difference was found between the preoperative and postoperative acoustic parameters.

CONCLUSIONS

Platysma myofascial flap provides the basic requirements for laryngeal reconstruction with its own favorable characteristics and also allows complete glottic closure without interfering with respiration and deglutition. This technique may be an effective alternative achieving an acceptable quality of voice.

Anatomical study of meandering and functions of human intralaryngeal artery

In recent years, partial laryngectomy and partial reconstruction are increasingly intended for conservation of functions of phonation and swallowing. In partial reconstruction, it is important to comprehend morphological characteristics of the blood vessels distributed in the larynx, but there have been only few reports discussing detailed information about them. Previous reports on laryngeal blood vessels have shown that branches of some arteries show remarkable "meandering". In the present study, we devised a method for objectively determining the morphological nature, "meandering" and assessed functions of the arteries. Intralaryngeal arteries were excised from the larynx of cadavers prepared for practice in anatomy, and images of the "meandering" artery were analyzed with NIH Image. The extent of "meandering" was expressed mainly as the ratio of the total length of the blood vessel to the distance between the starting point and the end point of meandering. The results showed that there was a significant difference in the extent of meandering between superior posterior and medial posterior branches of superior laryngeal artery. These arteries, which were distributed in the arytenoid region, were found to be of primary importance in partial laryngectomy and partial reconstruction of the larynx.

Vascularized hemitracheal autograft for laryngotracheal reconstruction: a new surgical technique based on the thyroid gland as a vascular carrier

BACKGROUND

The management of extensive laryngotracheal stenosis has been a challenge confronting head and neck surgeons for over a century. The key to the successful restoration of a stable airway is providing a cartilaginous infrastructure to provide support to withstand both the negative and positive lumenal pressures produced during normal respiration and deglutition. We introduce a novel technique for restoration of such defects.

METHODS

The blood supply to the thyroid gland by way of the inferior thyroid artery and the superior thyroid artery and vein are mobilized for transfer. One half to two thirds of the circumference of the adjacent tracheal rings are mobilized on the basis of the requirements of the stenotic segment. This mucochondrial composite tracheal flap is advanced superiorly to the ipsilateral "laryngeal" region where insetting of the cartilage and the mucosa is performed. Primary reconstruction or, more likely, a staged repair of the secondary tracheal defect is performed.

RESULTS

Three case reports are presented. The patients were successfully decannulated postoperatively, continue to have an adequate voice, and are tolerating a diet (3-27 months postreconstruction).

CONCLUSION

A new surgical technique for reconstruction of benign laryngotracheal stenoses is introduced to restore phonatory capability and a stable airway. The composite thyroid-tracheal graft based on the inferior and superior thyroid arterial pedicles allows a single-staged, primary reconstruction of the hemilarynx with a well-vascularized composite thyrotracheal flap that allows resurfacing as well as replacement of the infrastructure of the glottis and subglottis. This technique would be an excellent method to restore the cricoid ring following partial resection for primary cartilaginous tumors.