Preservation of the larynx after resection of a carcinoma of the posterior wall of the hypopharynx: Versatility of a free flap patch graft

Abstract

Background Preservation of the larynx after resection of a pharyngeal tumor remains a challenging problem for the head and neck surgeon. Methods Nine patients with T1 or T2 carcinoma of the posterior wall of the hypopharynx (UICC 1987), who were treated surgically between 1984 and 1994, were studied. All patients underwent surgical resection of the tumor with laryngeal preservation and immediate reconstruction with free flap transfer. A free forearm flap was transferred in four patients and a free jejunal patch graft, in five patients. Results There was one flap loss, due to venous thrombosis. Successful larynx preservation was achieved in the remaining eight patients (89%). Although there was one local control failure, three patients remained free of disease for more than 5 years. Conclusions Laryngeal preservation surgery using a free flap patch graft has proven very beneficial in selected cases with a carcinoma of the posterior wall of the hypopharynx. © 1997 John Wiley & Sons, Inc. Head Neck 19: 137–142, 1997.

Surgical management of posterior pharyngeal wall carcinomas: Functional and oncologic results

“…Regarding swallowing rehabilitation, results were similar between these two flaps, with a median time for removal of the feeding tube of 1 month in both groups. We do not have experience in reconstruction with a jejunal free flap patch graft, as described by Nakatsuka et al, 11 because we worried about mucous secretion and aspiration problems. This author did not experience such problems on the four patients in his study, but the results need to be confirmed with a larger series.…”

Squamous cell carcinoma and Zenker diverticulum

“…After consecutive intensive treatment and swallowing therapy, the patient started swallowing without aspiration 2.5-3 months after surgery. According to the international literature [25][26][27][28] swallowing can be achieved in such cases with hypopharyngectomy within 3-4 months, especially if there is a postoperative massive swelling, which is primarily resistant to medical therapy. Radical oncological surgical resection is the therapy of choice in cases of carcinoma in a Zenker's diverticulum.…”

Free-flap reconstruction for laryngeal preservation after partial laryngectomy in patients with extended tumors of the oropharynx and hypopharynx

“…Reconstruction of portions of the tongue or supraglottis is critical in order to obtain good functional results. Radial forearm flaps have been used successfully for larynx preservation in reconstructing the posterior wall of the hypopharynx [7,9]. Because of its versatility, this free flap can also be used to reconstruct laryngeal structures.…”

“…Since shrinkage of a flap may occur, especially after irradiation, the size of the free flap should be at least 10% larger than the area to which it will be grafted [7]. Because of the need for bulky reconstruction, the dimensions should be increased even more to ensure good larynx protection.…”