Cricohyoidopexy (CHP) is a surgical procedure performed after partial removal of the

larynx The larynx (), commonly called the voice box, is an organ (anatomy), organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal ...

due to

laryngeal cancer Laryngeal cancer is a kind of cancer that can develop in any part of the larynx (voice box). It is typically a squamous-cell carcinoma, reflecting its origin from the epithelium of the larynx. The prognosis is affected by the location of the tumo ...

. It is categorized under horizontal laryngeal surgeries, alongside cricohyoidoepiglottopexy (CHEP), which particularly preserves the

suprahyoid The suprahyoid muscles are four muscles located above the hyoid bone in the neck. They are the digastric, stylohyoid, geniohyoid, and mylohyoid muscles. They are all pharyngeal muscles, with the exception of the geniohyoid muscle. The digastr ...

epiglottis The epiglottis (: epiglottises or epiglottides) is a leaf-shaped flap in the throat that prevents food and water from entering the trachea and the lungs. It stays open during breathing, allowing air into the larynx. During swallowing, it closes ...

, performed due to especially for tumors in the glottic region (where the

vocal cords In humans, the vocal cords, also known as vocal folds, are folds of throat tissues that are key in creating sounds through Speech, vocalization. The length of the vocal cords affects the pitch of voice, similar to a violin string. Open when brea ...

are located). The procedures aim to achieve oncological control while preserving essential laryngeal functions such as breathing, swallowing, and phonation.

History

Cricohyoidopexy (CHP) was first described by E. Majer and W. Rieder in 1959 as a form of supracricoid partial laryngectomy. Cricohyoidoepiglottopexy (CHEP) was later described by Jean Jacques Piquet in 1974 as a modification of earlier techniques introduced by Majer and Rieder (1959) and by J. Labayle and R. Bismuth in 1971. The method was adopted in various surgical departments in the early 1980s as an alternative to total

laryngectomy Laryngectomy is the removal of the larynx. In a total laryngectomy, the entire larynx is removed (including the vocal folds, hyoid bone, epiglottis, thyroid and cricoid cartilage and a few tracheal cartilage rings) with the separation of the a ...

, particularly in patients with intermediate- to advanced-stage tumors.

Surgical technique

Resection

In both CHP and CHEP, the patient is placed

supine In grammar, a supine is a form of verbal noun used in some languages. The term is most often used for Latin, where it is one of the four principal parts of a verb. The word refers to a position of lying on one's back (as opposed to ' prone', l ...

with neck extension. Orotracheal intubation and nasogastric tube placement are standard, and a

tracheotomy Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision on the front of the neck to open a direct airway to the trachea. The resulting stoma (hole) can serve independently as an airway ...

is performed. A bilateral apron flap (Roux-Berger's bilateral incision) provides exposure and allows concurrent neck dissection. The thyroid cartilage and

are resected, preserving the

cricoid cartilage The cricoid cartilage , or simply cricoid (from the Greek ''krikoeides'' meaning "ring-shaped") or cricoid ring, is the only complete ring of cartilage around the trachea. It forms the back part of the voice box and functions as an attachment sit ...

hyoid bone The hyoid-bone (lingual-bone or tongue-bone) () is a horseshoe-shaped bone situated in the anterior midline of the neck between the chin and the thyroid-cartilage. At rest, it lies between the base of the mandible and the third cervical verte ...

, and at least one mobile arytenoid. The

is preserved. Resection includes the

aryepiglottic folds The aryepiglottic folds are triangular folds of mucous membrane of the larynx. They enclose ligamentous and muscular fibres. They extend from the lateral borders of the epiglottis to the arytenoid cartilages, hence the name 'aryepiglottic'. The ...

, vestibular folds,

thyroarytenoid muscles The thyroarytenoid muscle is a broad, thin muscle that forms the body of the vocal fold and that supports the wall of the ventricle and its appendix. It functions to shorten the vocal folds. Structure It arises in front from the lower half of the ...

, and the

cricothyroid ligament The cricothyroid ligament (also known as the cricothyroid membrane or cricovocal membrane) is a ligament in the neck. It connects the cricoid cartilage to the thyroid cartilage. It prevents these cartilages from moving too far apart. It is cut d ...

. The

pharyngeal muscles The pharyngeal muscles are a group of muscles that form the pharynx, which is posterior to the oral cavity, determining the shape of its lumen, and affecting its sound properties as the primary resonating cavity. The pharyngeal muscles (involunt ...

and paraglottic space are dissected. The superior laryngeal nerves are spared when possible. Frozen section analysis confirms clear surgical margins.

Reconstruction

Reconstruction involves suturing the cricoid cartilage to the hyoid bone and with or without the preserved epiglottis. The base of the tongue is included to stabilize the reconstructed laryngeal structure (neolarynx). Surgical sutures (e.g.,

Vicryl Vicryl (polyglactin 910) is an absorbable, synthetic, usually braided surgical suture, suture, manufactured by Ethicon Inc., a subsidiary of Johnson and Johnson. A monofilament version is also made for use in Ophthalmology, ophthalmic practice. ...

Dexon Polyglycolide or poly(glycolic acid) (PGA), also spelled as polyglycolic acid, is a biodegradable, thermoplastic polymer and the simplest linear, aliphatic polyester. It can be prepared starting from glycolic acid by means of polycondensation or ...

) are passed through the cricoid, hyoid, and epiglottis. A median double stitch and lateral stitches stabilize the neolarynx. If one arytenoid is resected, it is repositioned medially via an anterior cricoid suture. The constrictor muscles may be reattached to facilitate swallowing.

Postoperative care

Postoperative care includes monitoring for bleeding, infection, and aspiration. Tracheostomy decannulation and nasogastric tube removal are guided by swallowing assessments, often using functional endoscopic evaluation (FEES). Diet is progressively advanced from gelled water to solids. A gradual approach to tracheostomy closure is generally favored.

References

{{Respiratory system surgeries and other procedures Surgical oncology Surgical removal procedures Larynx surgery