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.

Abstract

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 7x 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.