Stoma recurrence after laryngectomy: Guiding principles of “anterior mediastinal tracheostomy"

•A combination of Sisson type 2,3 and 4 and unclassical type 4 is an atypical presentation of stomal recurrence.•Tracheal Stump must be diverted beneath the right subclavian artery in most situations where there is a significant submucosal spread downwards.•Ligation and Division of the Left innominate vein is mandatory to fashion a very low anterior mediastinal stoma.•Pectoralis major Flap is better harvested from the right chest when Left innominate vein is ligated and severed.