CLINICAL TECHNIQUES AND TECHNOLOGY Modified supracricoid laryngectomy Aldo Garozzo, MD, Eugenia Allegra, MD, Alessandro La Boria, MD, and Nicola Lombardo, MD, Catanzaro, Italy No sponsorships or competing interests have been disclosed for this article. S upracricoid laryngectomy in its most common modali- ties, cricohyoidopexy (CHP) 1 and cricohyoidoepiglot- topexy (CHEP), 2 is a conservative surgical technique whose principal objective is the natural restoration of the respira- tory function. However, both swallowing and phonation undergo important modifications. 3 The objective of this study was to maintain the surgical strategy of supracricoid laryngectomy while focusing on reconstruction of the glot- tic plane. An essential part of the study was to recreate the anatomical conditions that allow phonation using the ster- nohyoid muscles for neoglottis reconstruction. Subjects Fourteen consecutive patients affected by laryngeal carci- noma and treated with supracricoid laryngectomy (11 pa- tients with CHEP, 3 patients with CHP) between 2003 and 2007 were selected for this prospective study. The protocol was approved by the Institutional Review Board of Magna Graecia University of Catanzaro, Italy. All the patients were informed of the benefits, risks, and complications of this surgical technique and its alternatives before they gave their informed consent. All the patients were men, and their ages ranged from 45 to 75 years (mean 58.5 years). Nine patients had stage T1b cancer, seven of whom were treated with CHEP and two with CHP. Five patients had stage T2 cancer, four of whom were treated with CHEP and one with CHP. All the patients had mobile vocal cords and the arytenoids were preserved. They were clinically and radiologically N0. Surgical Technique In all patients, a preliminary tracheostomy was performed at the fourth to fifth tracheal ring under general anesthesia. A collar incision incorporating the tracheostomy was per- formed; the incision extended from the anterior border of the sternomastoid muscle on one side to the anterior border of the sternomastoid muscle on the other side. The skin incision was deepened through the platysma, the upper skin flap was elevated until the hyoid bone was exposed, and the lower skin flap was elevated to the inferior border of the cricoid. The midline fascia was incised to expose the strap mus- cles. The sternohyoid muscles on both sides were isolated and detached from the hyoid bone, leaving their inferior vascularization intact. Each sternohyoid muscle was fash- ioned into a tubular shape with 4-0 Vicryl (Johnson & Johnson, Belgium). Both inferior constrictor muscles along the oblique line of the thyroid cartilage were transected, and the superior neurovascular pedicle was identified and used to ligate the superior laryngeal artery and vein, preserving the superior laryngeal nerve. After transection of the cricothyroid muscles, the cricothyroid membrane was incised to detach the thyroid cartilage from the cricoid cartilage. The thyroid cartilage was removed with or without the epiglottis (CHP or CHEP, respectively) by transecting the inferior horn 1 cm from the cricoid to protect the recurrent laryngeal nerve. The sternohyoid muscles, prepared previously, were linked on the midline. They were then placed bilaterally onto the Received May 4, 2009; revised September 6, 2009; accepted September 23, 2009. Figure 1 The sternohyoid muscles were placed bilaterally on the free margins of the cricoid and anchored to the vocal apophysis of the arytenoids. Otolaryngology–Head and Neck Surgery (2010) 142, 137-139 0194-5998/$36.00 © 2010 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved. doi:10.1016/j.otohns.2009.09.020