Treatment of end-stage pharyngeal strictures after laryngectomy with fasciocutaneous microvascular reconstruction

• Published in: Oral oncology 2020-04, Vol.103, p.104556-104556, Article 104556
• Main Authors: Farlow, Janice L., Rosko, Andrew J., Spector, Matthew E.
• Format: Article
• Language: English
• Subjects: Constriction, Pathologic - surgery; Dysphagia; Female; Free Tissue Flaps - blood supply; Head and neck cancer; Humans; Laryngectomy; Laryngectomy - adverse effects; Laryngectomy - methods; Male; Middle Aged; Pharyngeal Diseases - surgery; Pharyngectomy; Radiation; Reconstruction; Reconstructive Surgical Procedures - methods; Stricture
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2019.104556

•There are limited solutions for pharyngeal stricture after laryngectomy.•Pharyngectomy with fasciocutaneous reconstruction is an effective option.•Secondary reconstruction allows elimination of tube feeding and diet advancement. Pharyngeal strictures can develop after laryngectomy for larynx cancer, particularly in combination with radiation. Some patients develop intractable strictures where conservative swallowing therapy and pharyngeal dilations fail. Secondary reconstruction of these patients has not been described in the literature. We report our experience with completion pharyngectomy and fasciocutaneous free tissue reconstruction for this patient population. Five subjects who had undergone laryngectomy and radiation were successfully reconstructed with fasciocutaneous free tissue transfer using the radial forearm or anterolateral thigh with minimal post-operative complications. Following surgery, enteral tube feeding requirements were eliminated, and all diets were advanced. A few patients still required a modified diet or continued dilations. We thus demonstrate that pharyngectomy with secondary reconstruction is an effective option for end-stage pharyngeal strictures, though this should only be undertaken with careful patient selection.