Successful construction of a mediastinal stoma after total removal of larynx and trachea.

In a 54-year-old woman the entire trachea and larynx were removed because of malignant tumor. The first attempt to construct a mediastinal tracheostoma with 1.5 cm left of the distal trachea failed due to stomal infection with aortic wall necrosis and bleeding. Dividing the ascending aorta mobilized the left main bronchus and allowed a stoma at the level of the carina to be constructed without tension. The aortic continuity was restored by a vascular prosthesis from ascending to abdominal aorta. The patient survived and the stoma healed primarily. One year postoperatively the patient is doing well without signs of recurrent tumor.