Abstract Objective: To quantify accurately the suprahyoid and inferior constrictor releases, which are used to decrease tension across a tracheal anastomosis performed after tracheal resection. Design: Intraoperative tension measurements at 0.5-cm intervals of the released laryngotracheal unit were obtained using a spring balance after division of the trachea. Subjects: A selected series of eight patients undergoing total laryngectomy for laryngeal carcinoma, excluding those with cervical soft-tissue involvement, tongue-base involvement, or a history of radiation therapy to the head and neck. Results: The suprahyoid and inferior constrictor releases together permit a tension-free, inferior displacement of 2 cm. The suprahyoid release alone permits an inferior laryngotracheal displacement of 3.5 cm without exceeding the critical, anastomotic failure tension of 1700 g. Using the releasing techniques together permits inferior displacement of 4 cm without notably exceeding this critical tension. Conclusions: The closure of 2-cm defects without a releasing procedure is supported by this study. Larger defects of 3.5 cm, and occasionally 4 cm, can be closed safely without exceeding the critical tension level using a suprahyoid release. This study supports the use of the suprahyoid and inferior constrictor releases together for the uncomplicated closure of 4-cm defects.(Arch Otolaryngol Head Neck Surg. 1995;121:1310-1313) References 1. Gerwat J, Bryce DP. The management of subglottic laryngeal stenosis by resection and direct anastomosis . Laryngoscope . 1974;84:940-957.Crossref 2. Biller HF, Munier MA. Combined infrahyoid and inferior constrictor muscle release for tension-free anastomosis during primary tracheal repair . Otolaryngol Head Neck Surg . 1992;107:430-433. 3. Montgomery W. Suprahyoid release for tracheal anastomosis . Arch Otolaryngol . 1974;99:255-260.Crossref 4. Mulliken JB, Grillo HC. The limits of tracheal resection with primary anastomosis . J Thorac Cardiovasc Surg . 1968;55:418-421. 5. Grillo HC, Zannini P. Complications of tracheal reconstruction . J Thorac Cardiovasc Surg . 1986;91:322-328. 6. Cantrell JR, Folse JR. The repair of circumferential defects of the trachea by direct anastomosis: experimental evaluation . J Thorac Cardiovasc Surg . 1961; 42:589-598. 7. Grillo HC. Circumferential resection and reconstruction of the mediastinal and cervical trachea . Ann Surg . 1965;162:374-387.Crossref 8. Sachs ME, Conley J, Rabuzzi DD. Intralaryngeal release for tracheal anastomosis . Ann Otol Rhinol Laryngol . 1983;92:482-484. 9. Dedo HH, Fishman NH. Laryngeal release and sleeve resection for tracheal stenosis . Ann Otol Rhinol Laryngol . 1969;78:285-296. 10. Mathey J, Binet JP, Galey JJ, Evrard C, Lemoine G, Denis B. Tracheal and tracheobronchial resections: technique and results in 20 Cases . J Thorac Cardiovasc Surg . 1966;51:1-13.
Archives of Otolaryngology - Head & Neck Surgery – American Medical Association
Published: Nov 1, 1995