Stoma recurrence after laryngectomy: Guiding principles of “anterior mediastinal tracheostomy

• Published in: Oral oncology reports Vol. 9; p. 100126
• Main Authors: Varghese, Bipin T., Vishwani, Ankit, Shivanesan, P.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.03.2024
• Subjects: Anterior mediastinal tracheostomy; Sissons classification; Stomal recurrence; Stump transpositioning; Anterior mediastinal tracheostomy; Sissons classification; Stomal recurrence; Stump transpositioning
• ISSN: 2772-9060; 2772-9060
• DOI: 10.1016/j.oor.2023.100126

Extensive radical resections of cervicothoracic malignancies or stomal recurrences after total laryngectomy are technically demanding involving the division of the thoracic trachea, resulting in an “anterior mediastinal tracheostomy”. The case in point is described in a patient who presented with a bleeding, partially obstructed stomal recurrence following salvage laryngectomy. We did a wide excision under frozen section control of the involved stoma and retrosternal trachea with an access manubrectomy, leaving 5 cm of the remnant trachea for end stomal fashioning. A pectoralis major myocutaneous flap was used for filling the dead space between the trachea and brachiocephalic artery and the remnant skin. Malignant cervicothoracic tumours can pose a significant threat to a patient's survival by compromising their airway centrally with or without the ability to swallow. In certain carefully selected cases, extensive resection with anterior mediastinal tracheostomy may be the only viable solution. •A combination of Sisson type 2,3 and 4 and unclassical type 4 is an atypical presentation of stomal recurrence.•Tracheal Stump must be diverted beneath the right subclavian artery in most situations where there is a significant submucosal spread downwards.•Ligation and Division of the Left innominate vein is mandatory to fashion a very low anterior mediastinal stoma.•Pectoralis major Flap is better harvested from the right chest when Left innominate vein is ligated and severed.