Modified Total Laryngectomy With Strap-Flap Technique in a Patient With Bovine Aortic Arch Anomaly: A Case Report and Literature Review.

Background: Total laryngectomy is an essential surgical intervention in the management of advanced laryngeal carcinoma. However, anatomical variations such as the bovine arch can complicate this procedure. The atypical branching pattern of the bovine arch may position major vessels closer to the tracheostomy site, increasing the risk of tracheo-arterial fistulization.

Methods: We present the case of a 71-year-old woman with bovine arch anatomy who underwent total laryngectomy. Preoperative assessment revealed an aberrant right common carotid artery (RCCA) located close to the tracheostomy site. Intraoperatively, the "strap-flap technique" was employed, positioning the strap muscles between the RCCA and the trachea to minimize friction and reduce the risk of tracheo-arterial fistula formation.

Results: The laryngectomy was performed successfully without any bleeding complications.

Conclusion: Preoperative assessment of aortic arch anatomy is essential for guiding surgical planning. Surgical modifications, such as the use of strap muscles or pectoralis muscle flaps, are crucial in preventing postoperative complications.