[The management of laryngotracheal defect derived from thyroid gland papillary carcinoma resection]

To investigate the preservation of the structure and function of the trachea and larynx, the management of laryngotracheal defect when trachea and larynx was involved.

To review the management and clinical results of 13 cases of thyroid papillary carcinoma with larynx and trachea involvement, the preservation of laryngotracheal structure and relative defect reconstruction of our department from 2007-2014. Those patients being performed total laryngectomy was excluded. 3 males and 10 females, aged from 46 to 67 years old with median age of 53 were included. Among them 8 cases were recurrent. The extent of the tumor foci was estimated with the help of computed tomography and laryngofiberoscope before surgery. Selective neck dissection, total thyroidectomy and related laryngotracheal resection was performed for the first time operation patient, while selective neck dissection, recurrent foci and related larynx and trachea resection was performed for those recurrent patients. Three kinds of modalities were applied to manage the laryngotracheal defect including to reconstruct with pedicled sternocleidomastoid clavicular periosteocutaneous flap, pedicled trapizius muscular flap and to preserve the remaining larynx and trachea and perform a stoma of larynx and trachea which repaired by a second-stage procedure. The patients were followed-up from half an year to 3 years.

Ten patients out of 13 decannulated while another 3 cases, 2 of which were performed local flap to reduce the stoma, wore tracheal tubes all time.

Either flap transfer or laryngotracheal stoma before second stage repair might preserve partial laryngotacheal anatomy and function in selected cases thus improve the life quality of the patients.