Reconstruction of Pharyngeal Defects

Yabe, Takako Eva; Ashford, Bruce

doi:10.5772/intechopen.94191

Cited by 4 publications

(1 citation statement)

References 87 publications

(98 reference statements)

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“…Herein-described epiglottis flap seems to represent an important technique for pharyngeal reconstruction after total laryngectomy; however, a few conditions have to be met before considering reconstruction with this local flap. As already mentioned, this technique can be appropriate when the primary closure, which is considered the first step of the reconstructive latter, is no longer feasible due to the lack of extra mucosal tissue ( 30 , 31 ). The pharyngoepiglottic folds have to be spared from the disease and also not resected as the ascending branch of the superior laryngeal artery runs towards the pharyngoepiglottic fold and supplies predominantly the ventral surface of the epiglottis ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Pharyngeal reconstruction after total laryngectomy with sliding epiglottis: technical aspects with retrospective review

Grošelj,

Tancer,

Jerman

et al. 2024

Front. Oncol.

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IntroductionSeveral techniques have been employed for defect reconstruction after total laryngectomy, among others sliding epiglottoplasty. As there is a paucity of data on sliding epiglottoplasty after total laryngectomy, this study aimed to present this reconstruction technique in detail with the retrospective analysis of the patients.MethodsWe retrospectively reviewed single-center medical records of patients who underwent pharyngeal reconstruction after total laryngectomy between 2007-2013, with a follow-up to 2020. The study included patients who had total laryngectomy performed followed by a primary closure or sliding epiglottoplasty. The patients were divided according to the pharyngeal reconstruction technique: sliding epiglottis (n = 38) and primary closure (n = 120).ResultsThe baseline characteristics of patients, TNM stages, and previous treatment strategies did not differ significantly between the sliding epiglottis and primary closure group. The postoperative complication rates, including the pharyngocutaneous fistulae formation and strictures were comparable between the analyzed groups; however, a slightly higher incidence of pharyngocutaneus fistulae was noted within the patients after sliding epiglottoplasty. Overall 3-year survival of patients who underwent the epiglottoplasty and primary closure group were 73.7% vs. 57.5%, respectively.ConclusionsSliding epiglottoplasty is considered a safe reconstruction technique. Although slightly better outcomes were noted within the epiglottoplasty group, it is still considered inferior to the primary closure. This technique ought to be considered in meticulously selected patients in whom primary closure is not feasible, epiglottis with nearby structures is spared from disease, and when the distal flaps are less appropriate or contraindicated.

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Section: Discussionmentioning

confidence: 99%

Pharyngeal reconstruction after total laryngectomy with sliding epiglottis: technical aspects with retrospective review

Grošelj,

Tancer,

Jerman

et al. 2024

Front. Oncol.

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Presence of postlaryngectomy pseudodiverticulum on barium swallow does not affect early dietary progression

Ananthapadmanabhan,

Wong,

Natsis

et al. 2024

Head & Neck

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BackgroundThe presence of a pseudodiverticulum of the anterior pharyngeal wall, or prominent “pharyngeal bar,” is a well‐known phenomenon that occurs following total laryngectomy, which can be visualized by nasolaryngoscopy or videofluoroscopy. Among the different techniques of pharyngeal reconstruction, there is higher incidence following primary vertical multilayered closure. It has been postulated to cause dysphagia and lack of dietary progression despite a paucity of data. However, the direct impact of pseudodiverticulum is less clear and anecdotally its presence and severity does not necessarily correlate with dysphagia.MethodsA retrospective case series was performed of all consecutive patients who underwent total laryngectomy or laryngopharyngectomy between 2015 and 2022 at two tertiary head and neck institutions. All patients underwent routine videofluoroscopy postoperatively for swallow assessment. The presence of pseudodiverticulum on postoperative contrast swallow study was recorded to investigate the relationship with patient's ability to tolerate oral intake at 3 months discharge from the hospital.ResultsOf 50 laryngectomized patients (mean age 63.8 ± 10.0, 86% male), the main closure techniques were primary vertical (n = 9, 18%), primary T‐closure (n = 14, 28%), and flap reconstruction (n = 27, 54%). Pseudodiverticulum was identified in 19 cases (38%). 43 patients underwent primary surgery and 30 had adjuvant radiotherapy. The presence of pseudodiverticulum was significantly associated with vertical primary closure versus non‐vertical (T‐closure or flap reconstruction) techniques (χ2 (df 1) = 7.4, p = 0.007, OR = 5.7, 95% CI 1.3–24.7). Pseudodiverticulum was not associated with an increased inability to tolerate solid intake or full diet compared to patients without pseudodiverticulum. 26.3% of patients with pseudodiverticulum were on full diet compared to 25.8% of patients without. The vertical closure technique showed no difference in ability to maintain solid intake compared with non‐vertical closure; however, no patients were on full diet. Only one patient in the pseudodiverticulum group required surgical management during the study period for retention.ConclusionThe presence of a pseudodiverticulum does not appear to be significantly associated with a need for postoperative dietary modification. The authors postulate that postlaryngectomy dysphagia is multifactorial with sensorimotor aperistalsis of the pharynx and cricopharyngeal stenosis. While a pseudodiverticulum is a common phenomenon, patients did not require modification of diet at higher rates than those without, and they seldom require intervention.

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