Hypopharyngeal Reconstruction: Possibilities, Outcomes, and Updates for Improving the Human Health for Quality of Life

Abstract

Hypopharyngeal carcinoma is usually present at late stages, necessitating an aggressive line of management consisting of surgical procedures, chemotherapy, and radiation therapy, depending on the case. Practitioners tend to support total laryngectomies or total esophagostomies for most cases of hypopharyngeal carcinoma. The extensive procedures needed will most probably require, depending on the residual defect, a follow-up reconstructive procedure that might require utilizing flaps. Types of reconstructive methods and types of grafts or flaps used could be divided into a multitude of categories depending on the magnitude, shape, extension, and whether the underlying defect that is being reconstructed is circumferential or not. These reconstructive procedures are aimed at improving the quality of life, improving the aesthetic outcome, and restoring the functionality of the pharyngoesophageal segment. When it comes to hypopharyngeal cancer, the most common kind is squamous cell carcinoma (SCC), which has the worst prognosis of all the head and neck malignancies. Overall, the 5-year survival rate remains low, despite recent advancements in diagnostic imaging, radiation, and chemotherapy, as well as enhanced surgical methods and techniques. Hypopharyngeal malignancies are more probable than other tumors to present with advanced primary illness, with nodal metastasis a distinct possibility. The size and amount of local dissemination of the original carcinoma, as well as the extent of involvement of regional lymph nodes, are the most critical factors in predicting prognosis. Hypopharyngeal cancers are more likely than other head and neck cancers to manifest with distant metastases at the time of diagnosis. The appearance of second primary tumors, as well as the development of distant metastases, is a contributing factor to poor survival rate. Imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) with contrast remain the gold standard for evaluating hypopharyngeal carcinoma in the early stages. In most cases, imaging leads to an increase in the tumor stage at the time of presentation. Objectives. The main objectives are to review the research published about flaps, outline the optimum situations that will dictate the usage of a few of the most often used flaps for the rebuilding of the hypopharyngeal segment defects, and outline some of the complications associated with reconstruction. Methods. The processing was carried out with the title-specific search of the PubMed database using the query terms “hypopharyngeal carcinoma” and “reconstruction” to identify the most relevant articles without restricting publication dates. Information about the types of defects and methods of reconstruction was extracted from the reviewed articles. Two books were also reviewed, which were Regional and Free Flaps for Head and Neck Reconstruction (second edition) and Head and Neck Reconstruction: A Defect-Oriented Approach. Conclusion. Deciding the appropriate approach to a case should be individualized and should depend on the capabilities of the center, the defect’s size and status, and lastly, the surgeon’s training. The use of interpretation in the diagnosis of flaps can offer the best results in restoring functionality and vascularity and might also offer improved cosmesis.

Identify metabolism-related genes IDO1, ALDH2, NCOA2, SLC7A5, SLC3A2, LDHB, and HPRT1 as potential prognostic markers and correlate with immune infiltrates in head and neck squamous cell carcinoma

“…Hypopharyngeal carcinoma is a kind of head and neck tumor which occurs between the level of the hyoid bone and the lower end of the cricoid cartilage ( 1 ). The most common form of hypopharyngeal cancer is squamous cell carcinoma (SCC), which has the worst prognosis of all head and neck malignancies ( 2 ). Although hypopharyngeal carcinoma accounts for only 3%–5% of head and neck malignancies, the 5-year survival rate is only 30% to 35% ( 3 , 4 ).…”

Jejunum free flap for head and neck reconstruction, a step‐by‐step surgical technique videos

“…First, patient survival, with the restoration of continuity between the esophagus and the pharyngeal structures, and second, the preservation of a vital function, swallowing. 2 The use of free flaps is known to have better functional results than the use of pedicled flaps. 3 Several reconstruction options can be proposed to the patient: jejunum free fap (JFF), fasciocutaneous flap, or musculocutaneous flap.…”

Increased response to TPF chemotherapy promotes immune escape in hypopharyngeal squamous cell carcinoma

“…Patients with HPSCC frequently present at an advanced stage which is characterized by extensive local spread and early metastasis (Uzcudun et al, 2001;Eckel and Bradley, 2019). HPSCC has a poor prognosis with an overall 5-year survival rate of only 25%-35% (Liu et al, 2020;Visini et al, 2021;Marzouki et al, 2022). Therefore, exploring effective targets to improve the prognosis of HPSCC is urgently required.…”