Functional results after total cricoidectomy with medial femoral condyle free flap reconstruction

Abstract

Our goal was to describe a laryngeal-preserving single-stage procedure for the treatment of low-grade chondrosarcomas of the larynx: a total cricoidectomy with medial femoral condyle flap reconstruction. The study was designed as a case series of three consecutive patients with low-grade chondrosarcomas of the cricoid cartilage lamina, diameter 4.4, 5.2, 3.8 cm, respectively, who underwent total cricoidectomy in 2012. Single-staged reconstruction of the defect with medial femoral condyle flap including the periosteum and thin underlying cortical layer of the bone was conducted. Oncologic and functional results were observed during 3 years of follow-up. No evidence of tumor recurrence was detected during follow-up. One month after surgery, all patients were able to tolerate a soft diet and to speak satisfactorily. None of the patients reported aspiration after surgery nor experienced aspiration-related problems, which was confirmed by means of the Leipzig-Pearson scale. The speech ability was good, maximum phonation time was 14, 18, 21 s, respectively, and the voice handicap index scores ranged from 24 to 36 and had improved noticeably at 1, 3 and 6 months follow-up. Two patients were ultimately decannulated, and one female still has a tracheostomy; however, she is able to keep the tracheostoma closed for most of the time, maintaining good phonatory and swallowing functions. Total cricoidectomy with reconstruction by means of medial femoral condyle flap may replace the total laryngectomy in large low-grade chondrosarcomas of the cricoid cartilage.

Medial Femoral Condyle Free Flap: A Systematic Review and Proportional Meta-analysis of Applications and Surgical Outcomes

“…Indeed, ear, temporo-mandibular-joint, tracheal, and cricoid reconstruction are examples of possible MFC-FF applications that were found during the systematic review but did not match the inclusion criteria. 55–58 Furthermore, no publication bias assessment method was conducted, as results were relatively homogeneous and close to the standard free flap failure rate.…”

Expanding Indications of the Medial Femoral Condyle Free Flap: Systematic Review in Head and Neck Reconstruction

“…1,12 This poses a limitation, as the SGA's shorter pedicle leads to higher risk of flap complications and failure, much like the iliac crest. 1,12,13,25,26 Laryngotracheal region 19,[32][33][34] Mandible 6,13,22,24,35,36 Maxillary alveolus 13,[19][20][21]37 Orbit 16,20 Palate 13,20 Other facial bony structures 19,[38][39][40] Problematic nonunions 6,20,36 Failed nonvascularized bone grafts 13,19,20,37 Recalcitrant defects 19,20,37 Osteoradionecrosis 13,16,20,22,24 Fig. 2.…”

Hemicricoidectomy with modified rotational thyro-crico-tracheal anastomosis: a newborn in the family of crico-tracheal resection and anastomosis techniques

“…The first reconstructive option requires complex techniques, frequently carried out by multiple-staged procedures, often deserving prolonged laryngeal stenting 7 , 15-17 . Another shortcoming of these types of procedures is the impossibility to completely reproduce the laminated airway structure, composed by a cartilaginous skeleton in support to a respiratory epithelium.…”