[The hyoid bone in reconstructive laryngeal and cervical surgery].
The hyoid bone, with its complex system of connected muscles, ligaments and membranes, provides a highly resistant anchor point in all cases of larynx tumour surgery requiring a "pexy" to reconstruct the upper respiratory tract. This bone can also be important in reconstructive cervical surgery employing myocutaneous flaps, especially after extensive tissue removal, such as in locally advanced larynx tumours (primary T4 lesions or recurrences after partial or subtotal operations) and some primary or recurring malignant cancers of the thyroid, parathyroid or pharyngoesophageal tract involving the larynx. In this study the importance is underlined of preserving the hyoid bone in all cases of cervical surgery in which a strong anchor is needed for repair, due to the radical nature of intervention. The clinical-surgical data are reported of 39 patients, 38 of whom affected with epidermoid carcinoma of the larynx with various degrees of differentiation and 1 with "tall cell" papilliferous thyroid carcinoma, observed and treated over the last three years. In horizontal supraglottic laryngectomy (HSL), but particularly in subtotal larynx surgery with cricohyoidoepiglottopexy (CHEP) and cricohyoidopexy (CHP), the hyoid bone allows a sort of anastomosis to be performed, using residual cartilage to make a "neo-larynx". In reconstructive cervical surgery after extensive tissue removal, such as in forward widened total laryngectomy (FWTL), the hyoid bone offers an excellent anchor for myocutaneous pedunculate "repair" flaps, which may be thoraco-dorsal or free revascularized, to ensure continuity between the muscle tissue of the base of the tongue and of the flap itself. The hyoid bone and connected structures thus provide a real support apparatus whose great versatility, due to its resistance and extreme mobility, makes it particularly useful during the reconstructive phase of cervical surgery.
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Istituto di Clinica Otorinolaringoiatrica, Università G. D'Annunzio, Chieti.
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D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006928:Hyoid Bone / Q000601:surgery*; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy / Q000379:methods; D007830:Larynx / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods
L'osso ioide nella chirurgia ricostruttiva laringea e cervicale.