Ten Years' Experience with Free Tissue Grafts for Glottic Reconstruction

Thirty-three cases of glottic reconstruction are presented. Free autogenous tissue transplants were used to reconstruct a pseudocord after extended frontolateral partial laryngectomy in which one arytenoid was excised. The observation period varied from 2 to 12 years. In 30 patients the reconstruction technique employed an autogenous free muscle transplant sutured into the endolaryngeal recipient muscle bed remaining after hemilaryngectomy. In three patients, free autogenous epiglottis was used instead of muscle. In every case the pseudocord tissue transplant was completely covered with advancement flaps of pyriform sinus mucosa. We believe this experience justifies the use of free autogenous tissue transplants into the endolarynx without fear of slough. Transplant shrinkage is fairly predictable and averages about one fourth of the original bulk of the implanted graft. Free tissue grafts for endolaryngeal reconstruction appear to possess the following advantages over extralaryngeal pedicles: (1) easy “tailoring” of the transplant; (2) easy positioning of the transplant directly opposite the retained functioning cord; (3) easy placement in the posterior commissure defect; (4) complete endolaryngeal relining by hypopharyngeal mucosa; (5) avoidance of stents or keels; (6) lack of distortion of extrinsic laryngeal motion and laryngeal tilt, which can be observed after pedicles are swung into the residual hemilarynx; (7) absence of contraction-retraction vectors associated with various extralaryngeal pedicles which can distort extrinsic laryngeal motion; (8) assurance of complete “air-tight” closure of the residual organ when pedicles are not placed into it.