Sternohyoid Myocutaneous Flap Research Articles

The one-stage technology of epiglottis function and voice reconstruction after total laryngectomy with the sternohyoid myocutaneous flap

Objective:To investigate the clinical effect of one-stage sternohyoid musculocutaneous flap after total laryngectomy for reconstruction of epiglottis function and vocalization. Methods:A retrospective analysis of 8 patients who underwent total laryngectomy from November 2019 to September 2020. The sternohyoid myocutaneous flap was designed after total laryngectomy. The lower edge of the flap was sewed with the posterior upper edge of the tracheostomy opening, and the lateral and medial edges of the flap were anastomosed to create a vocal tube. The lateral edge of the upper end of tube was sutured with the anterolateral wall of the hypopharynx, then made full use of residual epiglottis and tongue root tissue to reconstruct epiglottis function. Results:None of the 8 patients had serious complications after total laryngectomies. Fifteen months after operation,the vocal tube flaps survived and had intact structure under fiberoptic laryngoscope. All patients could speak clearly and forcefully, and the swallowing function was intact. Conclusion:The use of adjacent myocutaneous flap to construct the vocal canal and reconstruct the epiglottis function is a simple and effective technique that can be completed in one stage and improve the voicing of patients undergoing total laryngectomy.

Diagnosis and treatment of laryngotracheal stenosis induced by relapsing polychondritis

Objective:To investigate the clinical characteristics, management and prognosis of laryngotracheal stenosis induced by relapsing polychondritis. Method:A retrospective analysis was performed of 11 patients with laryngotracheal stenosis induced by relapsing polychondritis. Stenosis was classified as Myer and Cotton grade Ⅱ in 4 patients, grade Ⅲ in 3 and grade Ⅳin 4. Result:Long-term T-tube implantation of thoracic tracheal stenosis was performed in 1 patient, and one patient who had underwent 2 dilations was decannulated, and the tube was successfully extubated in 9 cases who had underwent laryngotracheal reconstruction with sternohyoid myocutaneous flap or costal cartilage. Conclusion:Treatment of laryngotracheal stenosis induced by relapsing polychondritis is challenging. If the surgical intervention was selected properly on an individual basis, favorable clinical outcome can be obtained.

Management of laryngeal stenosis after laryngeal cancer surgery

Objective:To evaluate the surgical methods and outcomes of laryngeal stenosis after laryngeal cancer surgery. Method:Nineteen patients with laryngeal stenosis caused by partial laryngectomy were retrospectively analyzed.Two cases were treated by endoscopic laser resection. Seventeen were treated by open surgery. Among them 15 used the sternohyoid myocutaneous flap and 1 thyroid alar cartilage and 1 hyoid bone as grafts. Result:Sixteen patients were decannulated and the overall decannulation rate was 84%. A silicone T tube was remained in place from 3 to 18 months, mean 10 months. Follow-up was obtained from 11 months to 8 years. Conclusion:Vertical partial laryngectomy easily lead to laryngeal stenosis. The sternohyoid myocutaneous flap is the major approach for laryngeal stenosis. Endoscopic laser resection is effective for mild stenosis.

Sternohyoid myocutaneous flap in pediatric laryngotracheal stenosis treatment

Objective:To assess the indications and outcomes of laryngotracheal reconstruction (LTR) using the sternohyoid myocutaneous flap (SMF) in pediatric patients with laryngotracheal stenosis. Method:Twenty patients (15 males, 5 females; mean age, 9 years old, range 3 to 14) with laryngotracheal stenosis who underwent SMF procedures at Tangdu Hospital between August 1991 and October 2014 were analyzed. Stenosis was classified according to the Myer-Cotton grading system. Four patients were grade Ⅱ, ten were grade Ⅲ, and six were grade Ⅳ. The mean length of stenosis was 1.8 cm (rang, 0.3-4.0 cm). Three patients had concomitant unilateral vocal paralysis and 2 had bilateral vocal paralysis. Result:Fourteen of 20 patients (70%) were decannulated. The prevalence of decannulation for grade Ⅱ, Ⅲ, and Ⅳ was 100%, 70%, and 50%, respectively. There were no severe complications. Conclusion:The SMF is a relatively simple and reliable method for LTR but should be used cautiously if employed in severe cases such as grade Ⅳ with long-segment stenosis.

Segmental tracheal resection and anastomosis for the treatment of cicatricial stenosis in cervical tracheal

To evaluate the efficacy of segmental tracheal resection with end-to-end anastomosis for cicatricial cervical tracheal stenosis. The clinical outcomes of 40 patients treated with tracheal resection were retrospectively reviewed. There were 28 male patients and 12 female patients with the age ranged from 6 to 64 years (mean 33.7 years). The degree of stenosis was classified according to Myer-Cotton classification as follows: grade Ⅱ (n=7), grade Ⅲ (n=22) and grade Ⅳ (n=11). The stenosis extension ranged from 1.0 to 4.3 cm (mean 2.5 cm). The causes of the stenosis were postintubation (n=33), cervical trauma (n=6) and resection of tracheal neoplasm (n=1). Thirty-four(85.0%) patients were decannulated and 6 failed. Of the 6 patients failed, 4 were decannulated after reoperation with the sternohyoid myocutaneous flap or thyroid alar cartilage graft. Complications occurred in 10 patients. In 8 patients granulation tissues formed at the site of the tracheal anastomosis, which needed endoscopic resction, and in 2 patients anastomosic dehiscence occurred. No injury to recurrent laryngeal nerve or trachoesophageal fistula occurred. Segmental tracheal resection with end-to-end anastomosis is an effective surgical method for tracheal stenosis, which has a higher successful rate for primary operation and shorter therapeutic period.

Treatments of oropharyngeal anterior wall cancer by transhyoid surgery radiotherapy

To evaluate the transhyoid resection of oropharyngeal anterior wall cancer and oncological outcomes of the surgery combined with radiotherapy. A total of 24 cases with carcinoma located in the anterior wall of oropharynx was reviewed. The TNM stages were as follows: T2 in 7 cases, T3 in 2 cases, T4 in 15 cases; NO in 7 cases, N1 in 4 cases, N2 in 12 cases and N3 in 1 case. Tumor resection was performed via transhyoid approach, including 9 cases with partial glossectomy + partial laryngectomy, 7 cases with partial glossectomy + total laryngectomy, 7 cases with total glossectomy + partial laryngectomy and 1 case with partial glossectomy alone pectoralis major myocutaneous flaps were applied to repair synchronously the defects of tongue and lateral pharyngeal wall in 16 cases and the defect of cervical skin in 1 case. Radial forearm free flap and sternohyoid myocutaneous flap were used to repair the defect of tongue and lateral and posterior pharyngeal wall in 1 case. Sternohyoid myocutaneous flap was applied to reconstruct the tongue base in 2 cases. Bilateral and unilateral neck dissections were performed in 20 cases and 4 cases respectively. Five cases received preoperative radiotherapy and 16 cases received postoperative radiotherapy. All cases had negative surgical margin. Pathological examination showed neck lymph metastasis in 17 cases (70.8%). Three patients had postoperative pharyngocutaneous fistula. Two of them who underwent partial glossectomy + total laryngectomy and pectoralis major myocutaneous flaps synchronously reconstruction suffered from pharyngocutaneous fistula 4 days after operation. The fistula was closed by re-suturation following debridement and 2 weeks dressing change. The other one who underwent partial glossectomy + partial laryngectomy suffered from pharyngocutaneous fistula during postoperation radiotherapy and healed by the pectoralis major myocutaneous repair. Tracheostomy tubes were removed within 1-6 months, with good voice and swallowing functions, in 16 of 17 cases who underwent partial laryngectomy. Another one failed to pull out tracheotomy tube because of dyspnea. Twenty one cases were followed up over 3 years and Kaplan-Meier survival analysis showed the 3-year overall survival rate was 72.6%. The transhyoid tumor resection is an effective surgical approach for oropharyngeal anterior wall cancer. The defect following tumor resection is commonly need repair synchronously with various flaps. Acceptable outcome could be received by surgery combined with radiotherapy.

輪状軟骨部分壊死を伴った声門下狭窄の治療

Two patients with inflammatory stenosis of the subglottic larynx and upper trachea due to high tracheostomies underwent an open treated reconstruction. Stenosis was observed at the level of the cricoid cartilage in one case, and at the cricoid cartilage and upper trachea in the other case. In both cases, a partial defect of the cricoid cartilage was observed on a preoperative CT scan of the larynx.Both patients were successfully treated using the “trough” method. In the initial stage, we created a trough after resection of the stenotic region through the laryngotracheal fissure. A stent formed from a silicon dental impression was inserted into the trough to maintain the wide patency of the laryngotracheal lumen. The trough was closed with a hinge flap internally and with an advancement rotation flap externally in one of the patients six months after the initial operation. In the other patient, the trough was closed with a sternohyoid myocutaneous flap internally and given an advancement flap externally four months after the initial operation.

The sternohyoid myocutaneous flap (rotary door flap) in complex laryngotracheal reconstruction

Laryngotracheal stenosis remains a formidable challenge to laryngologists, especially when complex and compounded. The multiple surgical techniques proposed for laryngotracheal reconstruction attest to the difficulties encountered in this procedure. Application of the sternohyoid vascularized myocutaneous flap or rotary door flap, together with judicious postoperative management of the tracheostomy with restricted stenting, can expand the surgical options, shorten the postoperative recovery, and raise the rate of success. This article focuses on explanation of the surgical approach and patient selection and treatment with detailed description of the surgical technique. This surgical approach has been applied in 48 patients with complex stenotic lesions during the past 17 years. Only 2 patients were treatment failures. Good results show the versatility and reliability of this reconstructive method.

Laryngotracheal Reconstruction: Extended Vertical Partial Laryngectomy: Reconstruction Combining Epiglottoplasty and the Rotary Door Flap

This article explores various surgical techniques for vertical, partial laryngectomy in the treatment of laryngeal cancer. Potential for reconstruction and broader indications for such surgical procedures may be achieved by combining laryngeal epiglottoplasty with the rotary door sternohyoid myocutaneous flap.

Reconstruction of Pediatric Larynx and Upper Trachea With the Sternohyoid Rotary Door Flap

The sternohyoid myocutaneous flap, the rotary door flap, is optimally oriented to serve in laryngotracheal reconstruction. It provides immediate, highly vascularized lining and structural support to the augmented airway. Therefore, it is one of the most versatile alternative methods available for surgical reconstruction of the stenosed larynx and trachea. Thirteen of 14 patients who were managed by the rotary door flap technique have been successfully decannulated. The features of the flap and the surgical technique are described with reference to modifications in the pediatric age group.

The rotary door myocutaneous flap. A reliable technique for laryngotracheal reconstruction.

We examined the possible uses of the "rotary door" sternohyoid myocutaneous flap (RDF) in laryngotracheal reconstruction. This well-vascularized myocutaneous flap, when rotated axially, can replace or widen the anterolateral walls of the airway. It provides a large epithelial surface, together with bulky structural support. The flap is readily available within the immediate surgical field and can replace large defects in the airway, from the level of the glottis to the cervical trachea. After extensive structural and soft-tissue loss of the larynx and trachea were produced to simulate commonly encountered traumatic and postsurgical stenotic conditions, the RDF was employed in 23 dogs in a single-stage laryngotracheal reconstruction. A stable, widely patent airway was achieved. The dogs were followed up for periods varying from three to six months. No complications or secondary stenoses were encountered. Photographic, radiologic, and endoscopic examinations demonstrated the viability and usefulness of this newly described flap. Long-term tracheostomy was used so that intraluminal stents and cannulas could be avoided. Histopathologic studies confirmed the integration of the RDF into the framework of the larynx and trachea. Application of this technique in cases of tumors, trauma, and stenosis of the airway is suggested.

Histologic changes in skin implanted into the larynx and trachea by myocutaneous flap reconstruction.

Skin is the tissue most readily available for relining the walls of the reconstructed larynx or trachea. Its use has been condemned in the past because of potential contracture, complications have occurred when free, split-thickness grafts were used. We studied the changes that develop within skin that is transferred into the lumen of the airway as part of a vascularized sternohyoid myocutaneous flap. Twenty-one dogs underwent reconstruction of laryngotracheal defects by a vascularized myocutaneous flap. The closely shaved and chemically depilated skin included in this reconstruction was ultimately found to be well healed to the adjacent mucosa. Flaps as large as 8 cm2 survived with no evidence of scaling, crusting, or contracture. The cutaneous appendages in the flaps were compared with those found in adjacent skin near the donor site. After proper depilation there was involution of cutaneous appendages. Scarring of the dermis appeared to add support to the grafts. Our findings demonstrate that the rotary door sternohyoid myocutaneous flap is a reliable, well-vascularized flap that can have extensive application in laryngotracheal reconstruction.

Near-total pharyngeal reconstruction by 'rotary-door' sternohyoid myocutaneous flap in the dog. A preliminary report.

Closure of the pharyngoesophagus after total laryngectomy or partial pharyngectomy is not a difficult problem in most cases. Primary suture repair of the defect is usually adequate, providing sufficient healthy mucosa is available. When this is not feasible, it may be necessary to mobilize tissue from distant sites. The deltopectoral and various myocutaneous flaps are often chosen for this purpose because of their reliability and versatility. Unfortunately, they necessitate either two-stage surgery or involve excessive bulk, and both methods result in unsightly defects, especially in women. The "rotary-door" sternohyoid myocutaneous flap avoids these drawbacks, while utilizing tissues within the surgical field in a single-stage procedure. Seven mongrel dogs underwent total laryngectomy and partial pharyngectomy. The pharyngeal defect was closed with a rotary-door sternohyoid myocutaneous flap. Three dogs had an uneventful recovery and two developed fistulae that closed spontaneously within three weeks of surgery. The pharyngocutaneous repair was found to be intact on postmortem examination.