Conservative Management of a Large Postlaryngectomy Neopharyngeal Diverticulum

Montague, Mary‐Louise; Davis, Brian; Riad, Magdy Amin

doi:10.1007/s00455-004-0015-4

Cited by 4 publications

(5 citation statements)

References 11 publications

(12 reference statements)

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“…This would then cause gradual herniation over time of the pharyngeal mucosa proximal to the stricture, and the pseudo‐diverticulum and pseudo‐epiglottis would become more apparent. Our high percentage of pseudo‐epiglottis formation is in accordance with the available literature, with an incidence varying from 35% to 86% 3,6,16–18 . It has been suggested that the pseudo‐epiglottis is more likely to occur following vertical closure of the neopharynx 2,5,19 .…”

Section: Discussionsupporting

confidence: 90%

“…Our high percentage of pseudo-epiglottis formation is in accordance with the available literature, with an incidence varying from 35% to 86%. 3,6,[16][17][18] It has been suggested that the pseudo-epiglottis is more likely to occur following vertical closure of the neopharynx. 2,5,19 One of the studies reported pseudo-epiglottis formation in 85% of patients after vertical closure, compared to only 18% following a T-shape repair.…”

Section: Discussionmentioning

confidence: 99%

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Swallowing outcomes following division of pseudo‐epiglottis resulting from vertical pharyngeal closure in laryngectomy

et al. 2023

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Background: Vertical closure of the pharynx after laryngectomy can result in an outpouch of the anterior wall of the neopharynx below the tongue base, called a pseudo-diverticulum. The prolapsed mucosa that separates the rest of the neopharynx from the pseudo-diverticulum is termed a pseudo-epiglottis.Methods: Prospective study of patients with pseudo-epiglottis. M. D. Anderson Dysphagia Inventory (MDADI) scores were used to assess swallowing outcomes pre-and post-pseudo-epiglottis division, including minimally clinically important difference (MCID) assessment.Results: Of 16 patients with a pseudo-epiglottis, 12 had dysphagia (75%). Symptomatic patients had significantly worse global MDADI and subscale scores. After division, the mean composite MDADI increased from 48.3 to 64.7 (p = 0.035), including a high MCID (16.4) with a similar improvement in the global question rating findings (31.1 vs. 60, p = 0.021). The MCID was significant for all MDADI subscales. Conclusions: Pseudo-epiglottis formation is associated with significantly worse global and subscale MDADI scores. A clinically-and statisticallysignificant improvement in the MDADI scores was found following surgical division.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Swallowing outcomes following division of pseudo‐epiglottis resulting from vertical pharyngeal closure in laryngectomy

et al. 2023

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“…The reported incidence of postoperative dysphagia varies from 17 to 72% [1, 5, 6]. This symptom has several causes, such as tumour recurrence, pharyngeal dysmotility, stricture formation, pharyngocutaneous fistulas, and postoperative radiotherapy but also the formation of a pseudo-diverticulum [7–9]. The pseudo-diverticulum is an anteriorly located mucosalized pouch of the neopharyngeal lumen, situated at the base of the tongue (Fig.…”

Section: Introductionmentioning

confidence: 99%

“…According to relevant literature the incidence ranges from 35 to 86% [7–9, 13, 14]. Although the possible association between closure technique in laryngectomy, pseudo-diverticulum and postoperative dysphagia has been described before, little scientific research has been published on this topic.…”

Section: Introductionmentioning

confidence: 99%

The influence of closure technique in total laryngectomy on the development of a pseudo-diverticulum and dysphagia

Kamp

Rinkel

Eerenstein

2016

Eur Arch Otorhinolaryngol

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ObjectiveIn total laryngectomy, the neopharynx can be closed in several ways. It is suggested that a pseudo-diverticulum is seen more frequently in patients closed with vertical closure than with “T”-shaped closure, causing postoperative dysphagia. We report the results of patients treated with vertical closure and “T”-shaped closure with regard to the formation of a pseudo-diverticulum and postoperative dysphagia.MethodsIn our retrospective cohort study, we identified 117 consecutive laryngectomized patients treated in the VU University Medical Center of Amsterdam between March 2009 and December 2013. Evaluations with statistical analysis of postoperative outcome measures (the formation of a pseudo-diverticulum and dysphagia), qualitative and quantitative variables were conducted.ResultsPatient demographics were similar between the vertical-shaped closure and the “T”-shaped closure groups. In 84.6% of patients with vertical closure, a pseudo-diverticulum was seen compared to 18.5% with “T”-shaped closure (p < 0.001). Dysphagia was increasingly seen in patients with a pseudo-diverticulum (60.5%) compared to patients without a pseudo-diverticulum (39.5%) (p = 0.090).ConclusionFormation of a pseudo-diverticulum is more frequently seen in laryngectomy patients closed with vertical closure than in patients closed with “T”-shaped closure of the neopharynx. It is favorable to implement “T”-shaped closure in laryngectomy.

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“…Following total laryngectomy and free-flap reconstruction, muscle contraction is limited at the suture lines within the operative site, reducing peristalsis during swallowing and often causing dysphagia [ 2 ]. Poor coordination of the remaining pharyngeal constrictor muscles can also contribute to dysphagia [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

CO2 Laser Division of Neo-Vallecula Improves Dysphagia in the Postlaryngectomy Patient: A Case Series and Review of the Literature

Saltagi

Wallace

Mantravadi

et al. 2020

Case Reports in Otolaryngology

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Objectives. To review the literature on neo-vallecula diagnosis and management and to report our findings regarding 3 patients who developed neo-vallecula in the context of free-flap pharyngeal reconstruction following total laryngectomy. Methods. This case series reports three patients who developed a neo-vallecula following a laryngectomy and free-flap pharyngeal reconstruction. All three patients were treated with a CO2 laser endoscopic procedure. Results. Neo-vallecula formation is thought to be related to tension on the neopharyngeal closure or closure technique following total laryngectomy. Diagnosis may be obtained with swallow studies, videofluoroscopy, or endoscopy. Treatment has included external excision and endoscopic procedures such as stapling, harmonic scalpel excision, and laser removal. We utilized an endoscopic approach entailing the use of a CO2 laser to divide the neo-vallecula, and all our patients reported improvement in their dysphagia. Conclusions. Treatment of an anterior neo-vallecula endoscopically using a CO2 laser is an effective way to treat dysphagia in patients following total laryngectomy with free-flap pharyngeal reconstruction.

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Conservative Management of a Large Postlaryngectomy Neopharyngeal Diverticulum

Cited by 4 publications

References 11 publications

Swallowing outcomes following division of pseudo‐epiglottis resulting from vertical pharyngeal closure in laryngectomy

Swallowing outcomes following division of pseudo‐epiglottis resulting from vertical pharyngeal closure in laryngectomy

The influence of closure technique in total laryngectomy on the development of a pseudo-diverticulum and dysphagia

CO2 Laser Division of Neo-Vallecula Improves Dysphagia in the Postlaryngectomy Patient: A Case Series and Review of the Literature

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