Suprahyoid Release: Surgical Steps
The suprahyoid release procedure involves dividing the suprahyoid muscle insertions at the hyoid bone and transecting the hyoid bone itself, leaving the small and large horns intact. This technique, described by Montgomery, is performed during tracheal resection to gain 2-2.5 cm of additional tracheal length and reduce anastomotic tension 1.
Surgical Technique
The procedure consists of the following key steps:
- Divide the cranial muscle insertions at the hyoid bone (suprahyoid muscles including mylohyoid, geniohyoid, stylohyoid, and digastric muscles)
- Transect the hyoid bone while preserving the small (lesser) and large (greater) horns
- This mobilization allows the larynx to descend, effectively lengthening the available trachea for tension-free anastomosis
Clinical Context and Indications
Suprahyoid release is indicated when resecting tracheal segments longer than 2.5 cm to minimize anastomotic tension 2. The technique is particularly valuable in:
- Post-intubation tracheal stenosis requiring long-segment resection
- Cricotracheal resections where additional length is needed
- Situations where thoracic release maneuvers alone are insufficient
Recent evidence from a prospective cohort of 40 patients demonstrates that routine suprahyoid release enables successful resection of longer tracheal segments without anastomotic complications 2.
Important Complications and Recovery
Temporary swallowing dysfunction is the primary concern with suprahyoid release:
- 15.7% of patients showed residual semisolid food in the vallecula and pyriform fossa
- 13% experienced aspiration and dysphagia postoperatively
- All swallowing symptoms resolved within 3 weeks and remained improved at 6 months 2
The Montgomery suprahyoid technique is preferred over the Dedo-Fishman infrahyoid approach because it causes less persistent swallowing difficulty and typically does not require postoperative tube feeding 1.
Comparison with Alternative Techniques
The suprahyoid release is superior to the alternative infrahyoid (thyrohyoid) release where the thyrohyoid muscle insertions are resected, the thyrohyoid membrane is divided, and both horns of the thyroid cartilage are cut. That approach results in prolonged swallowing difficulties 1.
In a series of 67 patients undergoing tracheobronchial resection with various release maneuvers, no anastomotic abnormalities (ischemia, necrosis, or dehiscence) were observed, confirming the safety and effectiveness of these techniques when properly executed 3.