Tracheal advancement with myomucosal island flap for partial laryngopharyngectomy defect reconstruction.

Abstract

Restoring the anatomy and function of a partial laryngopharyngectomy with hemicricoid defect is an extremely challenging area in head and neck cancer surgery. Procedures such as tracheal autotransplantation described for these defects are complex and attempted in very few centers. Therefore, the purpose of this article was to share our technique of reconstructing such defects with tracheal advancement with myomucosal island flap for laryngopharyngeal defect (TAMMIL), which allows functional reconstruction of the larynx. A 49-year-old man with carcinoma of the right pyriform sinus, postneoadjuvant chemotherapy with progressive disease underwent vertical partial laryngopharyngectomy. The resultant defect was reconstructed with tracheal advancement and islanded facial artery myomucosal (FAMM) flap. The patient is 1-year postsurgery, free of disease, decannulated, and taking oral feeds. Video fluoroscopy showed no evidence of aspiration. This technique is single-staged, easier compared to existing techniques, aids "like-for-like" reconstruction, and allows surgical organ preservation in selected laryngeal and hypopharyngeal cancers.