Bipedicled Vocal Fold Mucosal Flap: An Experimental Study.

OBJECTIVE: To determine the dimensions of mucosal defects that can be covered by a bipedicled vocal fold mucosal flap. METHODS: We used 20 adults human larynges (10 of each gender) excised from cadavers, divided into 2 groups of 10 larynges (5 of each gender) each. In one group (the normal flap group), we created the largest possible bipedicled vocal fold mucosal flap and then quantified the dimensions of the largest defect that could be covered by displacing the flap medially. In the other group (the augmented flap group), the flap was augmented laterally with mucosa from the laryngeal ventricle and we determined whether the larger flap would effectively cover larger defects. RESULTS: The mean width of mucosal defect capable of being covered was 1.51 mm when the normal bipedicled flap was employed and was 1.67 mm when the augmented flap was applied. However, the difference was not statistically significant. We found that defect size correlated with vocal fold length, width and flap size in the normal flap group, whereas it correlated only with vocal fold length in the augmented flap group. The bipedicled flap is capable of covering larger defects in males. CONCLUSION: Enlargement of a bipedicled vocal fold mucosal flap with laryngeal ventricular mucosa does not necessarily translate to an increase in the size of defect that can be covered. On average, the flap should be 30% larger than the width of the defect. The statistical model for predicting the defect size based on the vocal fold length, vocal fold width, and flap size has excellent predictive quality when a normal flap is employed.

'Mini-Microsuture Technique' for Phonosurgery: A New Simplified Method.

INTRODUCTION: Phonomicrolaryngeal surgery involves the surgical treatment of benign disorders of the vocal folds. Postoperative scar tissue in vocal fold mucosa is undesired because mucosal hypodynamia may lead to prolonged impairment in voice quality. This study aims to present and share the outcomes of a new endolaryngeal suture technique. METHODS: This study consists of patients who underwent vocal fold surgery followed by endolaryngeal microscopic suturation with a technique that we call the "mini-microsuture technique" between January 2018-December 2019. Videolaryngoscopic images were examined to observe the tissue healing process (suture elimination time, mucosal scar status, and wave pattern) at the first and the fourth week postoperatively. RESULTS: A retrospective analysis was made in 144 (57 males (39.5%) and 87 females (60.5%)) patients who underwent phonomicrosurgery with "Mini-microsuture technique." Mean age was 40.61 ± 13.54 (10-78) years. There were multiple pathological lesions in 41.66% (n: 60) of our patients, and 58.33% (n: 84) of them had single-lesion. 63.88% (n: 92) of the patients had bilateral vocal fold lesions where 36.22% (n: 52) of the patients had pathology in one vocal fold. CONCLUSIONS: The "mini-microsuture technique" is an easy and functional procedure that can be performed by a single surgeon under microscopy, which minimizes tissue trauma, prevents mucosal hypodynamia, and provides a better anatomical structure postoperatively for a symmetrical vibration. The technique does not significantly prolong operation time when mastered and is a cost-effective method in which surgery which can be concluded using a single suture material.

Sulcus Vocalis: Results of Excision Without Reconstruction.

OBJECTIVE: Sulcus is an epithelial invagination of the membranous vocal fold. Its phonatory effects are usually attributed to fibrosis, thinning, and/or the absence of the superficial lamina propria (SLP). Surgical treatment is typically focused on reconstruction of the SLP. The purpose of this study is to assess the effects of excision without SLP reconstruction or replacement. METHODS: Records of patients who underwent surgical treatment of sulcus vocalis (Ford type 3) by excision without reconstruction were reviewed for demographic and historical information. Pre- and postoperative stroboscopic examinations were evaluated blindly by fellowship-trained laryngologists using a modified Voice-Vibratory Assessment with Laryngeal Imaging assessment. A Wilcoxon signed-rank test was used to compare pre- and postoperative amplitude, mucosal wave, nonvibrating portion, regularity, erythema, and vascularity. RESULTS: Examinations of 16 vocal folds in 13 patients (8 females:5 males; mean age = 30 years, range 13 to 48 years) were evaluated by six raters each, yielding 168 sets of observations. Statistically significant improvement was seen in amplitude (95% confidence interval [CI] 3.6,14.3), mucosal wave (95% CI 6.1, 17.9), nonvibrating portion (95% CI -19.6, -2.7), erythema (95% CI -19.9, -3.3), and vascularity (95% CI -19.0, -0.75). The parameter of regularity, although improved, did not prove to be significant. CONCLUSION: Excision alone appears to be an adequate and generally successful treatment for sulcus vocalis (Ford type 3). In contrast to established paradigms, restoration of the SLP does not appear to be essential to meaningful clinical improvement. Significant pathologic effects of sulcus vocalis may result from epithelial abnormalities alone. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2208-2212, 2020.

Endoscopic Sealing With a Polyglycolic Acid Sheet for Restoration of Vocal Fold Mucosa in Dogs.

OBJECTIVES/HYPOTHESIS: Voice outcomes of cordectomy for early glottic cancer are often poor due to vocal fold scarring and tissue defects. Improvements in this aspect could make cordectomy a more acceptable treatment option than radiotherapy. We hypothesized that a polyglycolic acid (PGA) sheet could be used to cover vocal fold defects. The present study aimed to prevent vocal fold scarring after cordectomy using the PGA sheet. STUDY DESIGN: Animal experiment. METHODS: Nine male beagles were divided into three groups including a control group (n = 3). Following cordectomy, the vocal fold defect was covered with the PGA sheet plus fibrin glue (PGA group; n = 3) or with the PGA sheet plus fibrin glue containing basic fibroblast growth factor (bFGF; the PGA-bFGF group, n = 3). Vocal folds were chronologically observed, and larynges were removed 6 months after surgery. Mucosal amplitude was measured using a high-speed camera, and histological analysis was performed. RESULTS: The re-epithelialization process was delayed in the PGA and PGA-bFGF groups compared with the control group. The mucosal amplitude was significantly more normalized and the thickness ratio significantly higher in the PGA and PGA-bFGF groups compared with the control group. The PGA-bFGF group had the highest elastic fiber density, followed by the PGA group and then the control group, with a significant difference between the PGA-bFGF and control groups. CONCLUSIONS: The PGA sheet plus fibrin glue could serve as an effective regenerative scaffold for reconstructing vocal fold morphology and function after cordectomy, with the potential benefit of establishing an endoscopic sealing method for vocal fold defects. LEVEL OF EVIDENCE: NA Laryngoscope, 130:E436-E443, 2020.

LncRNA SNHG20 promotes the development of laryngeal squamous cell carcinoma by regulating miR-140.

OBJECTIVE: This study aims to investigate the expression level of long non-coding RNA (lncRNA) SNHG20 in laryngeal squamous cell carcinoma (LSCC), and to explore further whether it can promote the development of LSCC by regulating microRNA-140 (miR-140). PATIENTS AND METHODS: Expression levels of SNHG20 in 56 pairs of LSCC tissues and adjacent normal tissues were measured by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The relationship between SNHG20 expression with pathological parameters and the prognosis of LSCC was analyzed. Besides, the SNHG20 expression in LSCC cells was also analyzed by qRT-PCR. The SNHG20 knockdown and overexpression model were constructed by lentivirus transfection in AMC-HN-8 and Hep-2 cells. Cell counting kit-8 (CCK-8) and 5-Ethynyl-2'-deoxyuridine (EdU) assay were used to analyze the effect of SNHG20 on the biological function of LSCC cells. Finally, the dual-luciferase reporter gene assay was performed to explore the potentials of SNHG20 and miR-140 in LSCC. RESULTS: The SNHG20 expression in LSCC tissues or cells remarkably increased than controls, and the difference was statistically significant. The LSCC patients with the high expression level of SNHG20 were more likely to develop advanced tumor compared with patients with low expression of SNHG20. Moreover, the LSCC patients with the high expression level of SNHG20 had a shorter overall survival than those with low level. The cell proliferation ability significantly decreased in the SNHG20 knockdown group, while notably increased in SNHG20 overexpression group. MiR-140 was negatively correlated with SNHG20 in LSCC tissues and cells. Dual-luciferase reporter gene assay showed that SNHG20 could be targeted by miR-140 through a certain binding site. The cell rescue experiment also indicated that there was a mutual regulation between SNHG20 and miR-140, which could together affect the malignant progression of LSCC. CONCLUSIONS: We showed that the expression levels of SNHG20 in LSCC tissues or cell lines significantly increased and was associated with advanced tumor staging and undesirable prognosis of LSCC. In addition, SNHG20 could promote the malignant progression of LSCC.

Two-handed tying technique in vocal fold mucosa microsuture for the treatment of Reinke's edema.

BACKGROUND: Removal of Reinke's edema may result in moderate to large-sized mucosal defect on the vocal fold, which heals by secondary intention. Microsuturing this defect may lead to primary wound healing with fastened recovery and less scar, but costs extra time and effort. Exploring methods that can shorten microsuture time is helpful for the wider application of this technology. STUDY DESIGN: Retrospective. METHODS: 57 patients with Reinke's edema, who were admitted from November 2010 to June 2018, were enrolled as research subjects for the retrospective analysis. 27 patients were the knot pusher group (from November 2010 to March 2015), and 30 patients were the two-handed tying group (from April 2015 to June 2018). Evaluation indicators include the number of knots, the average time for suturing and tying the knot for each patient, and the occurrence of complications, subjective and objective voice assessments. RESULTS: All patients underwent successful operation. The average time for making knots in the knot pusher group and two-handed tying group was 668.40 ± 173.73 s and 328.73 ± 121.0 s, respectively, and there was a statistically significant difference between the two groups (p < 0.001). No significant difference was noted in the mucosal avulsion, overall incidence of complications between the groups, and no significant difference was found between the two groups in terms of the preoperative and 3-month postoperative subjective and objective indicators. CONCLUSION: Microsuturing of Reinke's edema microflaps using the two-handed tying technique can achieve the similar effect with the knot pusher method, and save operation time while the surgeon is well trained. LEVEL OF EVIDENCE: 4.

Mucosal impedance of the larynx: A technical report.

INTRODUCTION: Mucosal impedance testing measures changes in resistance to alternating electrical current. The purpose of this study is to establish the feasibility of mucosal impedance (MI) measurement in the pediatric larynx. METHODS: A flexible plastic catheter, whose tip contains paired 2 mm mucosal impedance, is directly applied to the larynx under suspension microlaryngoscopy. Milliohms of resistance is relayed real-time from the catheter and output onto a PC. Results were obtained safely over the course of 5 min of intraoperative time for all 49 patients undergoing routine microlaryngoscopy at a tertiary care pediatric hospital. RESULTS: The technique was successful in identifying MI values with reliable and reproducible results. The risk was minimal with no adverse events occurring. Impedance noise reduction was improved by the use of an aqueous gel coating on the probe and an emphasis on measurements of the interarytenoid space, which enabled the sensor rings to contact 360° of the mucosa. CONCLUSION: Laryngeal MI can be safely and reliably performed with reproducible measurements and minimal added procedure time.

Pressure induced tissue resection in the larynx: A preliminary canine study.

OBJECTIVES: The application of laser (light amplification by stimulated emission of radiation) energy in the larynx relies on thermal injury. The impact of this injury on adjacent tissue can be undesirable. Attempts have been made to limit the extent and range of injury to adjacent tissue. The O-Pel Surgical System (Precise Light Surgical, Inc., Campbell, CA), a new technology, utilizes kinetic energy through Pressure Induced Tissue Resection (PITR) (Precise Light Surgical, Inc.) to cut tissue, theoretically eliminating injury to adjacent tissue. The purpose of this study was to evaluate the PSL in canine vocal folds. METHODS: Four dogs underwent PITR incisions (4 mJ pulses at 200 Hz) on their vocal folds, through mucosa into the muscle. The animals were sacrificed at days 0, 3, 7, and 21 days postsurgery. The larynges were harvested and histology was performed with hematoxylin and eosin, Masson trichrome, and Verhoeff-van Gieson. RESULTS: At day 0, focal denudation of the epithelium and coagulation necrosis in the lamina propria and adjacent connective tissue are noted. On days 3 and 7, an inflammatory infiltrate of neutrophils is seen within the lamina propria and surrounding connective tissue with minimal edema and early deposition of collagen. At day 21, the mucosa is completely regenerated with the area of previous PITR into the muscle replaced with thick bundles of collagen. CONCLUSION: The unique PITR characteristics offer a potentially unique cutting technology for laryngeal microsurgery. The current canine study suggests appropriate and rapid healing. With refinements of the tip size of the probe and adjustment of energy, PITR will likely be an appropriate alternate to traditional lasers in laryngeal surgery. LEVEL OF EVIDENCE: NA. Laryngoscope, 129:2557-2562, 2019.

Improved Mucosal Wave in Unilateral Autologous Temporal Fascia Graft in Sulcus Vocalis Type 2 and Vocal Scars.

OBJECTIVES/HYPOTHESIS: We analyzed the results of 10 patients treated by unilateral autologous temporal fascia graft, comparing the pre and post surgery results, as well as the appearance of the wave and the intervals until the re-appearance of it. STUDY DESIGN: Retrospective, clinical case series. METHODS: Subjective and objective evaluation was preoperatively and postoperatively performed, using laryngovideostroboscopy, the Voice Handicap Index-10, GRBAS (grade, roughness, breathiness, asthenia, and strain), harmonics to noise ratio, Jitter, Shimmer, phonatory range, maximum phonation time, and S/Z ratio in all patients. Postoperative visits were scheduled after 1 week, 1 month, at 3 months, and at 6 months after the surgery. RESULTS: After surgery, we found significant differences in the maximum phonation time and the S/Z ratio (P <0.05). Most parameters of GRBAS also improved significantly, both in general and in the subscales, except for Breathiness and Asthenia (P <0.05). There was an average decrease in Voice Handicap Index-10 of 11.2 (P <0.05). At laryngovideostroboscopy, the mucous wave reappeared in all patients treated 1 month after surgery, and increased in amplitude until 6 months postoperative.

Influence of subglottic secretion drainage on the microorganisms of ventilator associated pneumonia: A meta-analysis for subglottic secretion drainage.

BACKGROUND: The influence of the subglottic secretion drainage (SSD) on the microorganisms of ventilator associated pneumonia (VAP) is still unclear.A meta-analysis focusing on the influence of the SSD on the microorganisms of VAP. METHODS: A comprehensive search was conducted through the online studies of PubMed, Embase, Cochrane Library, Google scholar, CNKI (China National Knowledge Infrastructure), and VIPI (Database for Chinese Technical Periodicals) using specific search terms.Included studies were randomized controlled trials (RCTs) that compare the microorganisms of VAP between SSD and standard endotracheal tube care in mechanically ventilated adults. RESULTS: Nine RCTs were eligible. There was no significant difference in the rate of VAP caused by nonfermentative bacteria and enterobacteria between SSD group and control group (OR = 0.73, 95%CI, 0.53-1.01; P = .06). The episodes of VAP caused by Gram-positive cocci and Haemophilus influenzae organisms were lower in the SSD group (OR = 0.29, 95%CI, 0.18-0.48; P<0.00001). Less mean volume of SSD daily was observed in VAP group (OR = -16.97, 95%CI, -29.87-4.08; P = .010). CONCLUSION: We found SSD to be associated with significant decreases in VAP caused by Gram-positive cocci and H influenzae organisms but no significant differences in VAP caused by nonfermentative bacteria and enterobacteria. Less mean volume of SSD daily was observed in VAP group.

Quantifying the Subharmonic Mucosal Wave in Excised Larynges via Digital Kymography.

OBJECTIVES: In this paper, a nonlinear least squares fitting method was proposed to quantify subharmonic mucosal waves. STUDY DESIGN AND METHODS: Subharmonic mucosal waves from 10 excised canine larynges were recorded using digital kymography and analyzed using nonlinear least squares and linear least squares methods. Amplitudes of fundamental and subharmonic mucosal wave components of right-upper, right-lower, left-upper, and left-lower vocal fold lips were calculated. Lastly, phase differences of fundamental and subharmonic components of the left and right vocal folds were compared. RESULTS: The results showed that the nonlinear least squares analysis method provides a more effective complement to the linear fitting method for subharmonic mucosal wave extraction. There was a significant difference in amplitudes between the subharmonic and the fundamental components of mucosal waves (P < 0.05). The phase differences of the fundamental and the subharmonic components of the right and left vocal folds were not significantly different. CONCLUSIONS: The application of the nonlinear least squares analysis method in digital kymography is useful for the characterization of subharmonic mucosal waves.

Isolated epiglottic lymphatic malformation in a 2-year-old: Diagnosis and treatment.

Airway obstruction in children has a wide differential diagnosis that includes laryngomalacia, infectious processes, paralysis, extrinsic compression, and other rare anatomic anomalies. Isolated laryngeal lymphatic malformations are rare developments that can manifest with clinically significant airway obstruction. To the best of our knowledge, there have been fewer than 20 reported cases. These laryngeal mucosal lesions are best managed with radiofrequency ablation or laser ablation. We present a case of a 2-year-old child who presented with airway obstruction, initially diagnosed with laryngomalacia, who was subsequently diagnosed and treated for an isolated epiglottic lymphatic malformation.

[Wound healing following laser cordectomy for early glottic carcinoma].

OBJECTIVE: To study the wound healing following CO2 laser microsurgery for early glottic cancer, and to evaluate the treatment outcomes and cost-effectiveness of microsurgery, open surgery and radiotherapy for early glottic cancer. METHODS: Thirty-six patients with early glottic carcinoma (T1-T2) treated by transoral CO2 laser microsurgery from January 2011 to June 2014 were observed, and 112 patients undergoing open approach and 27 receiving radiotherapy from January 2008 to June 2014 in our hospital were used as control. The wound healing process, the hospital stay, the cost, the oncologic and functional results were evaluated. RESULTS: The mean time of laryngeal mucous membrane stabilization in morphology was 93 days, less than 120 days in 91% cases. The average score of VHI-10 was 5.9, which was better in the cases with T1 than the cases with T2, and was worse in cases with the anterior commissure involvement. Transoral CO2 laser microsurgery offered a similar oncologic result, shorter hospital stay and lower cost compared with open surgery or radiotherapy. CONCLUSION: The transoral laser surgery could be a better choice for early glottic carcinoma because of good oncologic and functional results and less cost.

Surgical Treatment of Iatrogenic Ventral Glottic Stenosis Using a Mucosal Flap Technique.

OBJECTIVE: To describe a novel surgical technique for correcting postoperative ventral glottic stenosis (cicatrix or web formation) and the outcome in 2 Thoroughbred racehorses. STUDY DESIGN: Retrospective case report. ANIMALS: Thoroughbreds diagnosed with ventral glottic stenosis (n=2). METHODS: Horses presenting with iatrogenic ventral glottic stenosis and resultant exercise intolerance and abnormal exercise-related noise were anesthetized and a midline sagittal skin incision was made over the ventral larynx and between the sternohyoideus muscles overlying the cricothyroid notch. The cricothyroid ligament, attached laryngeal cicatrix, and overlying mucosa were sagittally sectioned at the dorsal aspect of the cicatrix on the left side. The laryngeal mucosa, cicatrix, and underlying cricothyroid ligament immediately rostral and caudal to the cicatrix were sectioned in a medial (axial) direction as far as the right side of the cricothyroid notch. After resection of the majority of the attached cicatrix tissue, the residual mucosal flap (attached to the right side of the larynx) was reflected ventrally and sutured to the attachment of the cricothyroid ligament on the right side of the cricothyroid notch, creating an intact mucosal layer on the right side of the ventral larynx. RESULTS: Both horses had good intralaryngeal wound healing with minimal redevelopment of ventral glottic stenosis at 5 and 9 months postoperatively and were successfully returned to racing with complete absence of abnormal respiratory noise. CONCLUSION: The unique laryngeal anatomy of horses, with a cartilage-free ventral laryngeal area (cricothyroid notch), allowed the use of this novel surgical technique to successfully treat ventral glottic stenosis.

Practice variations in voice treatment selection following vocal fold mucosal resection.

OBJECTIVES/HYPOTHESIS: To characterize initial voice treatment selection following vocal fold mucosal resection in a Medicare population. STUDY DESIGN: Retrospective analysis of a large, nationally representative Medicare claims database. METHODS: Patients with > 12 months of continuous Medicare coverage who underwent a leukoplakia- or cancer-related vocal fold mucosal resection (index) procedure during calendar years 2004 to 2009 were studied. The primary outcome of interest was receipt of initial voice treatment (thyroplasty, vocal fold injection, or speech therapy) following the index procedure. We evaluated the cumulative incidence of each postindex treatment type, treating the other treatment types as competing risks, and further evaluated postindex treatment utilization using the proportional hazards model for the subdistribution of a competing risk. Patient age, sex, and Medicaid eligibility were used as predictors. RESULTS: A total of 2,041 patients underwent 2,427 index procedures during the study period. In 14% of cases, an initial voice treatment event was identified. Women were significantly less likely to receive surgical or behavioral treatment compared to men. From age 65 to 75 years, the likelihood of undergoing surgical treatment increased significantly with each 5-year age increase; after age 75 years, the likelihood of undergoing either surgical or behavioral treatment decreased significantly every 5 years. Patients with low socioeconomic status were significantly less likely to undergo speech therapy. CONCLUSION: The majority of Medicare patients do not undergo voice treatment following vocal fold mucosal resection. Further, the treatments analyzed here appear disproportionally utilized based on patient sex, age, and socioeconomic status. Additional research is needed to determine whether these observations reflect clinically explainable differences or disparities in care. LEVEL OF EVIDENCE: 2c. Laryngoscope, 126:2505-2512, 2016.

Correlation Between Clinical Diagnosis and Pathological Diagnosis in Laryngeal Lesions.

OBJECTIVES: To evaluate the degree of agreement between the clinical and the pathological diagnosis in patients undergoing laryngeal microsurgery due to epithelial or edematous lesions of the vocal folds. STUDY DESIGN: This is a retrospective study. METHODS: The study was developed in the ear, nose, and throat clinic of a tertiary hospital, through chart review. We included all patients who underwent microsurgery of the larynx, whose videolaryngoscopic tests showed vocal fold lesions, from January 2003 to August 2014. During the study period, we identified 48 patients with epithelial and edematous lesions. The patients were divided into two groups. In group A, patients with edematous lesions with clinical diagnosis of polyps and Reinke edema were included. Group B comprised patients with epithelial lesions, as leukoplakic injuries. A correlation between histopathological findings and clinical hypothesis between these two groups of lesions was performed. RESULTS: In group B, there was agreement in 88.9% of cases between the clinical and pathological diagnosis. In group A, compatibility occurred in only 46.4% of cases. We observed a statistically significant difference between the compatibility of the clinical and pathological diagnosis just in edematous lesions (P = 0.029). CONCLUSIONS: The study showed the limitation of the pathological examination on edematous laryngeal lesions. On the other hand, on the epithelial lesions, there was more agreement between those diagnosis.

Long-term outcome of endoscopic shortening and stiffening of the vocal folds to raise the pitch.

In this study, we aimed to assess the long-term effects of the mucosal layer plastic surgery of the vocal folds performed on the voices of male-to-female transgenders. This retrospective cohort study enrolled 22 patients who were operated during 2004-2010 by a combined technique of transmucosal anterior suturing and stiffening of the vocal folds through a longitudinal cordotomy incision using CO2 laser. Long-term effects were assessed based on completed questionnaires on four different categories including subjective evaluation of patient's own voice perception and a standardized voice inventory (VHI), as well as an acoustic assessment and videolaryngoscopic examination. Out of the 22 patients contacted, 16 returned the questionnaires, and 13 of them participated in the subsequent acoustic analysis and videolaryngoscopic assessment. Results of the study were as follows: The total VHI score, after the procedure, was 32. F0 increased significantly for both the vowel/a/ and text from 157 to 207 Hz and 139 to 162 Hz, respectively. Perturbation measures did not show a significant change. F0 did not correlate with the VHI score. One patient had symptomatic anterior perforation that needed re-operation. The combination of transmucosal anterior suturing and stiffening of the vocal folds by laser cordectomy results in significant elevation of the F0 in the long term and in acceptable levels of VHI score compared to other reports. In conclusion, the results of the procedures show that it is enough to get the mucosal edges sutured together without the need to suture either the ligaments or the muscle of the vocal folds. The need for revision is minimal with this procedure.

Heterogeneous bovine acellular dermal matrix for mucosal repair in reconstructive surgery for laryngeal and hypopharyngeal carcinoma.

BACKGROUND: We performed this study to explore the clinical effects of a heterogeneous bovine acellular dermal matrix (ADM) used for repairing mucosal defects in reconstructive surgery following resection for laryngeal and hypopharyngeal carcinoma. PATIENTS AND METHODS: A summary analysis was carried out on the surgical data of 93 patients who underwent reconstructive surgery using a heterogeneous bovine ADM following resection of laryngeal and hypopharyngeal carcinoma. The patients underwent an electronic laryngoscope review. RESULTS: After 3-6 months, the repaired mucosa had replaced the mucosal defects in 88 patients who had undergone stage I reconstruction, recovering local function. Due to infection, 3 patients had a laryngeal fistula and 2 patients had a pharyngeal fistula; the fistula incidence rate was 5.4%. 86 patients underwent successful tracheal extubation (extubation rate, 92.5%). The duration from tracheotomy to extubation was 8-31 days; the average duration was 10.4 days. CONCLUSION: The heterogeneous bovine ADM is a new, safe, and effective material for reconstructive surgery. In patients with large mucosal defects, it avoids the trauma caused by flap repair.