[The use of hyoid osteomuscular flap in extended partial laryngectomy]

The surgical defect after conventional partial laryngectomy practically needs no special technique to repair. On conservation surgery for late (T3 and T4) cases a large part of the larynx is to be resected so that the margin of surgical clearance is ample and, at the same time, an appropriate method of reconstruction is mandatory to restore the essential functions of the larynx. For this purpose we developed a technique of osteomuscular flap to repair the defect left behind after a three-fourths laryngectomy (for supraglottic case) or an extended vertical partial laryngectomy (for glottic case). In both cases the arytenoid cartilage or the cricoarytenoid joint was resected to ensure the safety margin of resection. The mylohyoid muscle was severed at the upper border of the body of the hyoid bone. A small piece of the hyoid bone (about 5 mm) and its attached strap muscles were used. The muscles were made a 90 degree bent toward the laryngeal cavity. The hyoid bone was used to substitute the removed arytenoid and the muscles to bridge over the laryngeal lumen. The postericoid mucosa was advanced to cover the transplanted hyoid bone. Then the cut edge of the thyroid cartilage was lifted up and sutured with the base of the tongue to close the wound. 108 cases were treated within a period of 12 years (1979-1990). The three year survival rates for stage II and stage IV of supraglottic type (66 cases) were 78.6% and 66.7% respectively, and for stage II of glottic type (42 cases), 79.3%. The decannulation rate was 75%-85%, and 80% of the patients enjoyed a socially acceptable voice. All cases resumed normal mouth-food-taking.