Glosso-valleculo-epiglottectomy for a patient with recurrent cancer at the base of the tongue: Resection and reconstruction for recovery of morphology and function

Surgical resection is the only salvage method for recurrent cancer at the base of the tongue after chemoradiotherapy. When widespread invasion of tumor to the larynx is observed, total laryngectomy is inevitable. However, if the tumor is localized, a glosso-valleculo-epiglottectomy (GVE) with preservation of the vocal cords might be feasible. It is generally recommended to reconstruct the defect after GVE with either primary closure or a small local flap (e.g. cervical apron flap). However, the reconstructed morphology of the supraglottic space is different from the original, and moreover excessive tension arises between tissues. As a result, it could cause frequent postoperative leakage, infection, aspiration pneumonia, placement of permanent tracheotomy, unnatural voice, and airway disorder. In view of these issues, we performed GVE and reconstructed the defect as follows, and obtained favorable functional results for phonation and swallowing in a patient with recurrent cancer at the base of the tongue. (1) The sensory and motor nerves of the pharynx: the superior laryngeal nerve and vagus were preserved. (2) The left half of the hyoid bone and the muscles attached to it were preserved. (3) Laryngeal suspension was achieved using the preserved thyroid cartilage and hyoid bone. (4) Using a relatively bulky rectus abdominis myocutaneous (RAMC) flap, we attempted to reconstruct the bulging curve of the base of the tongue. (5) To prevent transplant tissue atrophy of the RAMC flap in the long term, we anastomosed the cervical motor nerve and the intercostal nerve of the RAMC flap. Here, we describe the surgical techniques and the postoperative voice and swallowing function.