A novel larynx‐preserving pharyngectomy technique using a thyroid gland flap after chemoradiotherapy

Ogawa, Tetsuya; Okamoto, Hiroki; Inukai, Daisuke; Sano, Rui; Katahira, Nobuyuki; Yamanaka, Syunpei; Yo, Kinga; Kan, Taichi

doi:10.1002/ccr3.2477

Cited by 3 publications

(5 citation statements)

References 11 publications

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“…The use of a TGF for glottic reconstruction after vertical laryngectomy was initially reported in 1990 by Kojima et al [9]. Since then, the effectiveness of a TGF has been demonstrated in larynx-preserving pharyngectomy and supracricoid partial laryngectomy after radiochemotherapy [6,10]. Furthermore, Ogawa et al [6] showed that a TGF with a sufficient blood supply prevents cervical infection and dehiscence.…”

Section: Discussionmentioning

confidence: 99%

“…Since then, the effectiveness of a TGF has been demonstrated in larynx-preserving pharyngectomy and supracricoid partial laryngectomy after radiochemotherapy [6,10]. Furthermore, Ogawa et al [6] showed that a TGF with a sufficient blood supply prevents cervical infection and dehiscence. We harvested a TGF from the superior aspect of the designated thyroid lobe.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are no definitive treatment options that effectively prevent postoperative complications. In the field of neck surgery, a thyroid gland flap (TGF) with a sufficient blood supply has been reported to reduce the risk of complications [6]. Surgical diverticulectomy requires an intraoperative neuromonitoring (IONM) system to show the proximity of the recurrent laryngeal nerve (RLN) to the base of the diverticulum.…”

Section: Main Textmentioning

confidence: 99%

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A novel Killian–Jamieson diverticulectomy using a thyroid gland flap: a case report

et al. 2020

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Background A Killian–Jamieson diverticulum is a rare pharyngoesophageal diverticulum that is radically treated by diverticulectomy. However, there is no consensus on whether cricopharyngeal myotomy is necessary, and the optimal surgical methods that prevent postoperative complications such as leakage are undetermined. Case presentation A 49-year-old man was referred to our hospital with oropharyngeal dysphagia while eating. The patient was preoperatively diagnosed with a Killian–Jamieson diverticulum based on radiographic and clinical findings and underwent a transcervical diverticulectomy. The recurrent laryngeal nerves were preserved using an intraoperative nerve monitoring system, and the diverticulum was identified without difficulty. A partial cricopharyngeal myotomy was performed to expose the base of the diverticulum. The diverticulum was transected transversally using a linear stapler under the guidance of intraoperative upper intestinal endoscopy. A thyroid gland flap supplied by the superior thyroid artery was harvested and placed overlapping the area of the partial cricopharyngeal myotomy. Due to the proximity of the recurrent laryngeal nerve course to the diverticulum stump, the staple line was not buried with sutures. The thyroid gland flap with its rich vascular supply was fixed to completely cover the staple line on the cut surface of the thyroid gland. The postoperative course was uneventful, without vocal cord paralysis. The patient was discharged on postoperative day 8. He developed no clinical signs suggesting leakage, recurrence, or adverse events. Conclusion Killian–Jamieson diverticulectomy using a thyroid gland flap and partial cricopharyngeal myotomy is a valid treatment option that may prevent complications and recurrence. Precise evaluation of the diverticulum using an intraoperative nerve monitoring system is crucial for the repair.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Main Textmentioning

confidence: 99%

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A novel Killian–Jamieson diverticulectomy using a thyroid gland flap: a case report

et al. 2020

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“…The thyroid gland flaps were completely adapted to the neck defects and prevented leakage, thyroid cartilage infection, and necrosis even after high-intensity chemoradiotherapy. Particularly in the case of reconstruction for hypopharyngeal cancer, the arytenoid height reconstruction was constitutive, and this improved quality of life in terms of swallowing 15 (Fig. 10 ).…”

Section: Discussionmentioning

confidence: 99%

“…We therefore used this thyroid gland flap for salvage head and neck surgery. 13 – 15 The method uses the same surgical site and the flap can be raised by the head and neck surgeons themselves.…”

Section: Introductionmentioning

confidence: 99%

Thyroid Gland Flap for Minimally Invasive Reconstructive Head and Neck Surgery

Ogawa

Inukai

Okamoto

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Head and neck surgery sometimes causes small defects, and salvage surgery after chemoradiotherapy poses some risk because of damage to the surgical site from the previous treatment. We have developed a novel thyroid gland flap for head and neck surgical reconstruction and here we describe elevating the flap, including arc rotation, size, and suture technique, and our outcomes to date. Methods: Thyroid gland flap reconstruction was performed in 13 cases (11 patients) between July 2009 and May 2020. The clinical importance and adverse effects of the procedure were examined. Thyroid function and blood flow of the flap were assessed, and the status of the flap and irradiated recipient tissue was examined histopathologically. Results: Median age at surgery was 64.6 years (range 49–77 years). Two of the patients underwent reconstruction with a thyroid gland flap twice. There were 4 cases of primary head and neck cancer resection with neck dissection in which the flap was harvested from the thyroid gland as reinforcement. In 1 case, surgery was performed for cervical esophageal diverticulum. In all cases, the arc was limited to 6 cm and suturing was basic. There were no complications of the surgical procedure, and the postoperative course was uneventful. Contrast-enhanced computed tomography revealed adequate enhancement of the flap. Postoperative thyroid function was normal. The thyroid gland flap was firmly adapted and fused with the irradiated recipient tissue. Conclusion: The thyroid gland flap could be an effective tissue flap fed by the superior thyroid arteriovenous pedicle for head and neck reconstruction.

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The use of thyroid flap for preserving laryngeal function in laryngeal cancer

Wang,

Yang,

Tang

et al. 2024

Head & Neck

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BackgroundPreserving laryngeal function after partial laryngectomy for laryngeal cancer is an important consideration. Therefore, we examined the use of thyroid flaps for this purpose.MethodsWe analyzed 21 patients who underwent thyroid flap reconstruction after partial laryngectomy for laryngeal cancer in the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University from January 2010 to January 2020. All patients were male and aged 51–64 years. Seventeen patients underwent modified tracheocricohyoidoepiglottopexy, and the remaining four patients underwent modified cricohyoidopexy. The thyroid flap was pedicled from the superior thyroid blood vessels. In the modified tracheocricohyoidoepiglottopexy, the flap was turned to cover the area between the tracheal ring and epiglottis to reconstruct the anterior wall of the cricoid cartilage, whereas in the modified cricohyoidopexy, it was turned over between the cricoid cartilage and tongue root to reduce anastomotic tension. A total of seven patients underwent radiotherapy and chemotherapy after surgery.ResultsThyroid flap reconstruction was successfully performed in all patients. The postoperative hospitalization time was 9–21 days, the postoperative nasal feeding time was 18–47 days, and the tracheotomy tube was removed 30–160 days after surgery. No laryngeal stenosis, flap necrosis, bleeding complication, or dysfunction of the thyroid and parathyroid glands was observed after surgery. Two patients experienced wound infections about 1 week after discharge and were admitted again for antibiotic treatment. After dressing and compressing the neck wound, the patients were discharged. Three patients experienced local tumor recurrence after surgery, two of whom did not receive radiotherapy and chemotherapy after modified tracheocricohyoidoepiglottopexy. No patients had distant metastasis after surgery.ConclusionsThyroid flaps have significant application value in the reconstruction of the laryngeal cavity after partial laryngectomy for laryngeal cancer. It has high safety and feasibility, convenient surgical procedure, and satisfactory postoperative outcomes.

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A novel larynx‐preserving pharyngectomy technique using a thyroid gland flap after chemoradiotherapy

Cited by 3 publications

References 11 publications

A novel Killian–Jamieson diverticulectomy using a thyroid gland flap: a case report

A novel Killian–Jamieson diverticulectomy using a thyroid gland flap: a case report

Thyroid Gland Flap for Minimally Invasive Reconstructive Head and Neck Surgery

The use of thyroid flap for preserving laryngeal function in laryngeal cancer

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