Composite hyoid-sternohyoid interposition graft in the surgical treatment of laryngotracheal stenosis

Abstract

This article reports six patients with severe laryngotracheal stenosis. The causes of stenosis were tracheotomy (two cases); prolonged endotracheal intubation (one case); laryngeal trauma (two cases); and surgery with postoperative chemo- and radiotherapy, addressing a thyroid gland follicular adenocarcinoma (one case). Two patients were already tracheotomized. The main postoperative complication was necrosis of the graft in a female patient who had previously undergone treatment for thyroid follicular adenocarcinoma. All patients were decannulated 6 months postoperatively. Five patients were then regularly followed up, but we lost contact with one patient. Comparison between pre- and postoperative pulmonary function testing revealed an increased maximum inspiratory flow (Vi max50) in five cases between 0.57 l/s and 2.18 l/s. A helical scan with 3-dimensional reconstruction of the cervical area in four patients confirmed the presence and preservation of the hyoid bone graft. Four patients remained satisfied with their postoperative voice quality, one patient was dissatisfied, and one patient was not followed up. This technique is effective in adults with severe laryngotracheal stenosis, restricted to the first tracheal rings, providing one takes into consideration the main contraindications of the procedure: past history of radiotherapy and thyroid surgery.

Vascularized Hemitracheal Autograft for Laryngotracheal Reconstruction: A New Surgical Technique Based on the Thyroid Gland as a Vascular Carrier

“…Current reconstructive procedures for complex laryngotracheal stenosis in the adult include HSIGs, 6,11–13 composite nasal septal graft, 14 corniculate‐cuneiform flap, 15 thyroid cartilage, 16 scapula free flap to reestablish cricoid framework following an extended hemilaryngectomy, 17 allograft replacement of the trachea 18 , and tracheal autotransplantation. 19,20 …”

Traumatic laryngotracheal stenosis treated by hyoid–sternohyoid osseomuscular flap combined with xenogenic acellular dermal matrix: A case report and literature review

“…The advantages of this technique include the absence of a risk of graft rejection because the hyoid bone is an autologous material, the requirement for only one incision because the bone graft is near the stenosis and within the same operative field, and the minimal risk to damage to the recurrent laryngeal nerves. 8 , 9 Additionally, it is an easy, feasible, and effective technique for reconstruction of laryngotracheal stenosis. The decannulation time seems to be shorter than that associated with the costal graft technique.…”

“…A composite hyoid–sternohyoid osseomuscular flap is commonly used to support the injured laryngotracheal framework, especially when the anterior cricotracheal architecture has been destroyed by trauma or chondritis. 8 - 10 Xenogenic acellular dermal matrix (ADM) was recently used to repair a tracheal defect caused by resection of a tracheal tumor. 11 To the authors’ knowledge, however, no reports have described the use of ADM to treat laryngotracheal stenosis.…”

Composite Hyoid Bone Graft Interposition for the Treatment of Laryngotracheal Stenosis

“…Furthermore, long-term stability of the grafted hyoid bone was reported at follow-up examinations conducted more than 5 years postoperatively [5]. Although other sporadic reports showed successful outcomes [6,7,8,9], the composite hyoid interposition graft technique for LTS has not yet been accepted widely.…”

“…If not only structural support but also sufficient epithelialization is needed, as observed in case 2, it is recommended to graft skin or oral mucosa onto the raw surface of the lumen after the excision of scar tissue, as previously reported [9]. …”