Laryngeal transposition flap for reconstruction of large oral cavity defects

Resection of the entire tongue and floor of the mouth, with or without the anterior mandibular arch, may necessitate sacrifice of the larynx to prevent life-threatening aspiration and poses a significant reconstructive dilemma. Regional cutaneous or myocutaneous flaps can provide adequate healthy tissue for repair, but share the inherent disadvantage of resurfacing the oral cavity with skin (which may be hair bearing), rather than mucosa. Moreover, cutaneous flaps usually necessitate a planned orocutaneous fistula and secondary closure, and bulky myocutaneous flaps may interfere with oral competence. Larynx transposition has been used for some time at Memorial Sloan-Kettering Cancer Center to repair selected large oral cavity defects resulting from resection of the entire tongue and floor of the mouth. This report illustrates the laryngeal transposition flap which is developed from the skeletonized, laryngofissured larynx based on the superior laryngeal arteriovenous pedicle. The advantages and disadvantages of this technique, as compared with alternative methods of reconstruction, are discussed.