Corniculate reconstruction after arytenoid resection in supracricoid laryngectomy.

INTRODUCTION Surgical organ preservation approaches constitute important treatment options for laryngeal cancer. Supracricoid partial laryngectomies (SCPLs) are open surgical techniques designed to resect selected advanced endolaryngeal tumors without major invasion of the infraglottis, involvement of the posterior commissure, or fixation of the cricoarytenoid (CA) joint. One of the key oncologic principles in SCPLs in achieving local control is the en bloc resection of the tumor with wide muscular and mucosal margins in continuity with the paraglottic space and the thyroid cartilage. 1,2 To best achieve complete resection of the tumor, ipsilateral arytenoid cartilage resection may be required. Arytenoid resection will create a posterior gap in the neoglottis, increasing the risk for postoperative aspiration. Our group advocates reconstruction with an ipsilateral corniculate flap to create a neoarytenoid and maximize functional outcomes. In our experience, the corniculate flap prevents severe aspiration and increases the chances for a better speech outcome. In the current report, technical operative details to perform the corniculate flap will be provided along with illustrative images of the CA joint, arytenoid, and corniculate cartilage as well as adjacent musculature at the time of arytenoid disarticulation. Videos of intraoperative corniculate flap and arytenoid repositioning as well as a postoperative video after corniculate flap reconstruction are provided online. The utility of the flap in the reconstruction after arytenoid resection in SCPL will be discussed emphasizing the functional reconstructive advantages.