Sternomastoid Myoperiosteal Flap for Reconstruction of the Subglottic Larynx

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Abstract
Reconstruction of the subglottis is usually required after resection of cricoid cartilage or tracheal tissue in cases of trauma, subglottic stenosis, or invasive thyroid carcinoma. There are multiple techniques available for reconstruction of the subglottic larynx, but most of them have a high rate of complications or graft failure. We have found the sternocleidomastoid myoperiosteal flap to be an ideal means of reconstruction. In an experimental study, we performed subglottic reconstruction using the sternomastoid myoperiosteal flap on 15 mongrel dogs to determine the presence of bone formation versus calcified fibrous scar. Radiologic studies suggested apparent metaplastic bone formation at the graft site, and histologic studies confirmed this. Functionally, 12 dogs had stable airways without stridor or subglottic narrowing. Three dogs died of complications. With successful reconstruction of large defects in the canine subglottis, attempts to repair large subglottic and tracheal defects in the human are feasible.