Suprahyoid and Inferior Constrictor Release for Laryngeal Lowering

Objective: To quantify accurately the suprahyoid and inferior constrictor releases, which are used to decrease tension across a tracheal anastomosis performed after tracheal resection. Design: Intraoperative tension measurements at 0.5-cm intervals of the released laryngotracheal unit were obtained using a spring balance after division of the trachea. Subjects: A selected series of eight patients undergoing total laryngectomy for laryngeal carcinoma, excluding those with cervical soft-tissue involvement, tongue-base involvement, or a history of radiation therapy to the head and neck. Results: The suprahyoid and inferior constrictor releases together permit a tension-free, inferior displacement of 2 cm. The suprahyoid release alone permits an inferior laryngotracheal displacement of 3.5 cm without exceeding the critical, anastomotic failure tension of 1700 g. Using the releasing techniques together permits inferior displacement of 4 cm without notably exceeding this critical tension. Conclusions: The closure of 2-cm defects without a releasing procedure is supported by this study. Larger defects of 3.5 cm, and occasionally 4 cm, can be closed safely without exceeding the critical tension level using a suprahyoid release. This study supports the use of the suprahyoid and inferior constrictor releases together for the uncomplicated closure of 4-cm defects. (Arch Otolaryngol Head Neck Surg. 1995;121:1310-1313)