Suspicion of cricohyoidopexy line rupture after supracricoid partial laryngectomy and the value of computed tomography to exclude this complication.

Abstract

We presented a 48-year-old man who underwent supracricoid partial laryngectomy with cricohyoidoepiglottopexy. He developed diffuse subcutaneous emphysema and saliva aspiration on the first postoperative day, arousing suspicion of a pexy line rupture. Palpation of the cricohyoid suture line and a lateral cervical X-ray were not helpful. Laryngeal computed tomography (CT) obtained demonstrated an undisturbed cricohyoidoepiglottopexy suture line. Some of the neck sutures were removed, a drain was placed under the neck flap, a tight dressing was applied, and surgical exploration was not necessary. Subcutaneous emphysema regressed in the following days and no other problem was seen. Subcutaneous emphysema was attributed to the air escape from the cricohyoid approximation line. Following supracricoid partial laryngectomy, rupture of the cricohyoidopexy line is a rare but serious complication that needs urgent exploration. Therefore, when there is suspicion, laryngeal CT is very important to rule out this condition. Moreover, a close cooperation is necessary with the radiologist who may not be familiar with disturbed anatomy by previous surgery.