Inverted epiglottis: a postoperative complication of supracricoid laryngectomy with cricohyoidoepiglottopexy.
OBJECTIVE
Among the 50 laryngeal cancer patients who received SCL-CHEP between 1997 and 2008, we experienced three patients with complete epiglottis prolapse, which obstructed the neoglottis. By defining this complication as "Inverted epiglottis" and presenting the clinical features, we intend to elucidate the mechanism, risk factors, and management of this complication.


METHODS
Details of the clinical features are presented. We conducted the following analyses: (1) distance from anterior commissure to the upper resected end of the surgical specimen was grossly measured. (2) Based on the analysis of sagittal cut CT images, the level of vallecula was identified and compared with the level of hyoid bone. (3) Distance between hyoid bone and cricoid arch (cricohyoid gap) after SCL-CHEP was measured using sagittal cut CT images.


RESULTS
Prolonged edema of the neoglottis and delayed stomal closure were the main symptoms. In patients with the vallecula lower than the hyoid bone, excessive resection of the epiglottic petiole (anterior commissure-upper edge>25 mm) might be a risk factor.


CONCLUSIONS
We reported a post-SCL-CHEP complication "Inverted epiglottis". Extensive excision of the epiglottic petiole, patients with a low vallecula profile, and incorrect suturing of epiglottic petiole during pexis are the three factors most related. Inverted epiglottis was treatable and most of the laryngeal function could be retrieved.
Nakayama
Meijin
M
Department of Otorhinolaryngology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 252-0374, Japan. meijin@med.kitasato-u.ac.jp
Okamoto
Makito
M
Seino
Yutomo
Y
Miyamoto
Shunsuke
S
Hayashi
Seiichi
S
Masaki
Takashi
T
Yokobori
Satoru
S
Takeda
Masahiko
M
D000368:Aged; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D003413:Cricoid Cartilage / Q000601:surgery*; D004825:Epiglottis / Q000601:surgery*; D006801:Humans; D006928:Hyoid Bone / Q000601:surgery*; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D011391:Prolapse; D012086:Reoperation / Q000379:methods; D012307:Risk Factors; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D014140:Tracheotomy / Q000379:methods