Virtues of routine suprahyoid release during tracheal resection and anastomosis in patients with post intubation stenosis

Postintubation tracheal stenosis is the most common cause of benign tracheal stenosis. Surgical treatment is more challenging in long-segment stenosis. Suprahyoid release can increase tracheal length resected without anastomotic tension in patients with post-intubation tracheal stenosis. Its effect on swallowing has not been objectively studied and this article aims to explore its virtues and potential complications in a tertiary center for airway surgery. A prospective cohort study was conducted on forty consecutive patients from June 2020 till December 2023. Patients of both genders had tracheal resection anastomosis surgery with routine suprahyoid muscle release for resected tracheal segment of more than 2.5 cm in length aiming to decrease the anastomotic tension. Within two weeks postoperatively, a video naso-laryngoscope was done on all the patients to detect any vocal cord disorders, then they were examined by video fluoroscopy swallowing study VFSS to detect swallowing problems. Follow up was done for 6 months postoperatively. 40 patients were studied. Twenty-five patients (62.5%) were males. 21 patients (52.5%) had a cricotracheal resection. VFSS was performed on 38 patients (two patients excluded for serious morbidity). Six (15.7%) and four (10.5%) patients had residual semisolid and solid food in the vallecula and pyriform fossa respectively during swallowing. Five patients (13%) out of eight patients with abnormal VFSS had aspiration and dysphagia. Video nasolaryngoscopy was done pre- and post-operatively and showed that 7 patients (17.5%) had unilateral vocal cord paralysis, two of them had the same lesion preoperatively. Two patients developed postoperative anastomotic complications. All symptoms of dysphagia improved within 3 weeks of the procedure and improvement persisted for 6 months. Suprahyoid muscle release had a considerable reversible drawback on the process of swallowing. Its routine use in high-risk patients requiring long segment tracheal resections could be considered.