Neoglottis reconstruction with sternohyoid muscles on upper-tracheal orifice after laryngectomy

Ideal speech restoration remains a difficult challenge for patients undergoing laryngectomy so far. Our aim was to explore the feasibility of neoglottic reconstruction with sternohyoid muscles on upper-tracheal orifice after total laryngectomy which can obtain relatively ideal voice rehabilitation. Fifteen male patients are laryngectomized, of whom eight with standard total laryngectomy and seven underwent nonstandard total laryngectomy with epiglottis conserved. After laryngectomy, the upper margin of the anterior hypopharyngeal mucosa (postcricoid mucosa) was stitched to the posterior margin of upper-tracheal orifice and a triangle-shaped neoglottis on upper-tracheal orifice was reconstructed using bilateral sternohyoid muscles near the hyoid bone which were sutured to the posterior wall and bilateral of upper-tracheal orifice. Then tracheolingual root anastomosis was done and reconstruction surgery was completed. Finally, a satisfactory voice was achieved in 14 of 15 patients except one whose neoglottis is stenosed and 11 cases had no severe complications including aspiration erroneous deglutition. The stomach catheters were removed successfully from 4 to 6 weeks after surgery in 11 cases, respectively. The neoglottis had to be closed in three patients because of aspiration problem. One neoglottis was closed 3 weeks after surgical reconstruction because of tracheal rings tear which created a bigger neoglottis. One neoglottis was removed 32 moths after total laryngectomy due to big neoglottis. Another one was closed 3 weeks after surgery by reason of the fear of aspiration without psychological preparation. Therefore, it is feasible to use the sternohyoid muscles for creation of a neoglottis on upper-tracheal orifice and provide an alternative surgical method of the voice restoration for the patients after laryngectomy.