SUPRAHYOID AND INFERIOR CONSTRICTOR RELEASE FOR LARYNGEAL LOWERING

Objective: To quantify accurately the suprahyoid and inferior constric tor releases, which are used to decrease tension across a tracheal ana stomosis performed after tracheal resection. Design: Intraoperative te nsion measurements at 0.5-cm intervals of the released laryngotracheal unit were obtained using a spring balance after division of the trach ea. Subjects: A selected series of eight patients undergoing total lar yngectomy 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 co nstrictor releases ogether permit a tension-free, inferior displacemen t of 2 cm. The suprahyoid release alone permits an inferior laryngotra cheal displacement of 3.5 cm without exceeding the critical, anastomot ic failure tension of 1700 g. Using the releasing techniques together permits inferior displacement of 4 cm without notably exceeding this c ritical tension. Conclusions: The closure of 2-cm defects without a re leasing procedure is supported by this study. Larger defects of 3.5 cm , and occasionally 4 cm, can be closed safely without exceeding the cr itical tension level using a suprahyoid release. This study supports t he use of the suprahyoid and inferior constrictor releases together fo r the uncomplicated closure of 4-cm defects.