One‐Stage Reconstruction of Partial Laryngopharyngeal Defects

Abstract

Advanced-stage lesions of the hypopharynx or tongue base often involve the larynx. The difficulty of reconstructing large partial laryngopharyngeal defects can result in total laryngectomy being performed to avoid the assumed problems with aspiration. This article describes the first reported experience using the pectoralis musculocutaneous flap for primary one-stage reconstruction of laryngopharyngeal defects following resection of advanced-stage lesions, to reconstruct both the laryngeal and the pharyngeal components of the defect. In this group of 21 patients, there were 16 with hypopharyngeal and 5 with tongue base cancers. Two had received prior treatment, and all received some form of postoperative radiotherapy and/or chemotherapy. Six patients experienced complications, including two fistulae, three wound infections, two myocardial infarctions, and one colon perforation. There were no instances of stenosis of the reconstructed segment. The length of hospitalization ranged from 9 to 60 days, the average being 17 days. Forty-seven percent (21) of the patients were not tolerating an oral diet at the time of discharge. However, 15 patients (71%) ultimately were eating by mouth, with 13 (62%) achieving an oral intake of liquids and solids. This analysis supports the hypothesis that the pectoralis major musculocutaneous flap is an effective one-stage primary reconstruction technique for laryngopharyngeal defects in patients either who have received prior therapy or who will receive postoperative therapy.

Tissue‐conserving surgery for prognosis, treatment, and function preservation

“…Contemporary reconstructive tissue transferring techniques have also improved the chances of preserving function. The literature now includes descriptions of techniques using musculocutaneous flaps 28 or free flaps 29 demonstrating that important organs such as the larynx and pharynx do not have to be totally resected but can be reconstructed in such a fashion to preserve swallowing and speaking function.…”

Microvascular Flap Reconstruction of Major Pharyngeal Resections With the Intent of Laryngeal Preservation

“…The introduction of local reconstruction techniques and the use of regional pedicled flaps allowed resection of these lesions while maintaining separation of the aerodigestive tract from the neck. Schuller et al 7 reported using the pectoralis major flap to reconstruct partial laryngopharyngeal defects. In this series, only 1 of 21 patients had to be converted to a total laryngectomy owing to aspiration, and 31 of 43 patients (72%) had some oral intake.…”

Surgical Treatment for Hypopharynx Carcinoma: Feasibility, Mortality, and Results

“…Surgery, usually in combination with postoperative radiotherapy, is believed to provide the highest cure and local control rates in patients with cancer of the hypopharynx 2–5 . Even more important, surgery provides immediately successful and long‐lasting palliation for airway obstruction, obstructive dysphagia, and aspiration since local control is frequently achieved even in locally advanced cancer 6–10 . However, the risks of surgery (bleeding, fistula, infection, and death) are too high to perform laryngopharyngectomy for patients with unresectable disease and for those presenting with poor performance status.…”