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Video

Facial Plastic and Reconstructive Surgery

(A405) Case Report: Management of Submental Lymphedema Causing Obstructive Sleep Apnea in a Total Laryngectomy Patient

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Alexia Paxton

    Medical Student, 3rd year
    University of Tennessee Health Science University, College of Medicine
    Memphis, Tennessee, United States

    • Co-Author(s)

  • Justin M. Soffer, MD

    Resident Physician
    University of Tennessee Health Science Center, Department of Otolaryngology–Head and Neck Surgery
    Memphis, Tennessee, United States

    • Co-Author(s)

  • C. Burton Wood, MD

    Assistant Professor
    University of Tennessee Health Science Center
    Memphis, TN, United States

    • Senior Author(s)

  • AE

    Anas A. Eid, MD

    Chief, Division of Facial Plastic & Reconstructive Surgery
    University of Tennessee
    Memphis, Tennessee, United States

Disclosure(s):
Alexia Paxton: No relevant relationships to disclose.
Justin M. Soffer, MD: No relevant relationships to disclose.
C. Burton Wood, MD: No relevant relationships to disclose.


Introduction: Total laryngectomy (TL) is a surgically altered airway indicated in cases of laryngeal/hypopharyngeal cancer, which virtually resolves all cases of comorbid obstructive sleep apnea (OSA) by removing or bypassing the typical upper aerodigestive tract structures implicated in its pathogenesis. Despite this, we present a rare case of extrinsic OSA in a TL patient due to stomal occlusion related to submental lymphedema and acquired lipodystrophy, which is managed with a functional direct Neck Lift.

Methods: This case report discusses a 61-year-old female patient with a history of T3N0 laryngeal squamous cell carcinoma managed with total laryngectomy. Approximately two years post-treatment, she began experiencing nocturnal apneic episodes and daytime somnolence due to stomal occlusion caused by submental lymphedema and excess adiposity. The treatment involved a direct central neck excision of skin and subcutaneous tissue, lymphadenectomy, neck liposuction, and a Z-plasty Neck Lift. The surgical approach was designed to relieve functional obstruction while maintaining an acceptable cosmetic outcome.

Results: The patient demonstrated marked symptomatic improvement in nocturnal breathing and stomal patency postoperatively. Physical examination revealed an improved cervicomental angle, and a well-healed incision with absence of significant fibrosis or unsightly scarring at 3 months follow up. The patient reported substantial improvement in her overall symptoms, including better stoma accessibility and sleep quality.

Conclusions: External OSA in post-TL patients is a rare but but clinically significant complication, often exacerbated by lymphedema and upper body adiposity. Surgical interventions focusing on maintaining airway patency offer a viable management strategy. This case highlights the importance of identifying and addressing such uncommon complications, particularly in TL patients with submental adiposity and lymphedema and those with a larger body habitus.