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

Abstract

Partial laryngeal resection often results in major aspiration problems, making larynx preservation during surgical removal of tumors of the oropharynx and hypopharynx impossible. However, free flaps can be used to reconstruct perilaryngeal tissue, thus preserving the larynx and ensuring a better quality of life for patients. We present the results of forearm free-flap reconstruction of the supraglottis in 22 patients who underwent resections of extended squamous cell carcinomas of the oropharynx and hypopharynx. A total of 9 patients had T3 lesions and 13 had T4 lesions. All patients were additionally treated with radiation therapy alone (to 70 Gy) or in combination with chemotherapy (Cisplatin; 5-fluorouracil). The mean follow-up was 2.4 years. In four patients, tracheostomy could be closed. Five patients suffered from severe aspiration, one of whom had to undergo a laryngectomy. Six patients had mild aspiration and 7 patients had no aspiration, but extensive edema made decanulation impossible. A total of 13 patients were free of disease, 4 patients died of disease, 1 patient died as the result of a second primary cancer and 1 patient died of other causes. Three patients are alive with persistent tumor. Although the majority of patients experienced a better quality of life as a result of larynx preservation, aspiration has remained a problem following treatment.

Preservation of laryngeal function through reconstruction of the supraglottis and thyrohyoid membrane with a chimeric anterolateral thigh flap after supraglottic laryngectomy: A case report and literature review

“…Chronic aspiration was noted in three of seven patients and tracheostomy stoma closure was not possible in these patients. Schwager et al (1999) similarly reported a high rate of chronic aspiration after radial forearm flap reconstruction in their case series including 22 patients. In 18 of the patients, the tracheostomy cannula could not be removed.…”

“…While voice preservation may be achieved, supraglottic laryngectomy often results in chronic aspiration (Breunig et al, 2016). Various attempts to address this problem have been undertaken (Table 1; Bloching & Berghaus, 2004; Dong et al, 2009; Grajek et al, 2015; Hamoir et al, 2012; Hsiao et al, 2010; Mannelli et al, 2013; Masuda et al, 2013; Mihara et al, 2011; Sakuraba et al, 2008; Schwager et al, 1999). Bloching & Berghaus (2004) combined a radial forearm flap with nasoseptal cartilage aimed to reconstruct the epiglottis in a case series of seven patients with supraglottic laryngeal cancer.…”

Hypopharyngeal Cancer

“…Median labiomandibular glossotomy and transoral approach can also be employed for small lesions of the posterior pharyngeal wall. The reconstruction following excision of larger posterior wall lesions involves a free vascularised graft (Jol et al, 2003;Schwager et al, 1999). Tumours arising in the postcricoid area are usually presented as advanced lesions.…”

Rehabilitation des Schluckverm�gens nach Tumorresektion

“…10-15% überdimensioniert sein. Diese Feststellung wird auch von anderen Autoren bestätigt, die Rekonstruktionen des Zungengrundes und der Supraglottisregion mit freien Lappenplastiken durchführen [8,18]. Das Problem der Lappenschrumpfung zeigte sich eindrucksvoll bei einem unserer Patienten (Patient 4) mit zweizeitiger Rekonstruktion nach Abb.…”