The solution in functional rehabilitation after destruction of the larynx: the tracheostoma closed.
A bayonet-shaped airway allowing free respiration and undisturbed deglutition was reconstructed in 2 young women who had undergone tracheotomy and radiotherapy for thyroid carcinoma. The laryngeal vestibule, glottis, and subglottis had been destroyed, and the air passages were closed. An external gutter and an anterior tracheal wall were created in a multistage procedure. In 1 patient, the hypopharynx and upper esophageal segment were reconstructed with bilateral pectoralis major musculocutaneous flaps, which disfigured the breast. The two displaced nipple-areola complexes were properly repositioned using skin expanders and island flap transfer, and the breast was remodeled with prostheses. Our results suggest that this method of laryngotracheal reconstruction may also be applied in laryngectomized patients in whom only part of the epiglottis and the aryepiglottic folds remain. Although the procedure is lengthy and difficult, it is recommended for extensive lesions in fully cooperative patients.