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

INTRODUCTION Primary closure (PC) has been used as the standard surgical technique for defects after supraglottic laryngectomy (SL). In the head and neck cancer surgery textbooks and literature, this relatively simple method has also been recommended for the closure of surgical defects after hyo-sub-glosso-epiglottectomy (HSE) or anteriorly extended supraglottic laryngectomy, in which the base of the tongue is removed with supraglottic structures during SL. However, this closing method ignores the original three-dimensional morphology of the supraglottic space that plays a critical functional role in phonation, respiration, and swallowing. Consequently, even after simple SL, patients who undergo PC suffer from frequent postoperative complications, including unclear voice, insufficient airway, and aspiration pneumonia, which often require placement of permanent tracheal stoma, gastric tube, and gastrostomy. These unfavorable outcomes become more prominent in patients with HSE due to the reduced volume of the base of the tongue. In particular, the enhanced risks of acute and persistent postoperative aspiration pneumonia occasionally require the sacrifice of the preserved larynx to save the life of the patient. In addition, this reconstruction method imposes excessive tension between sutured tissues, causing frequent postoperative leakage, infection, and fistula formation, especially in cases of salvage surgery. To overcome these critical problems, we reconstructed the supraglottic space after HSE with a rectus abdominis myocutaneous (RAMC) flap in a series of three patients including one salvage case. The purpose of this method was to create a sufficient convex shape that hangs over the remaining larynx expecting that it might function as a neoepiglottis. This method worked well, and all three patients demonstrated quite satisfactory functional results compared to the PC method. Surgical techniques of this novel reconstruction method are described herein.