Pharyngeal reconstruction by anterolateral thigh flap with vastus lateralis muscle transfer for effective swallowing after total glossolaryngectomy: A case report

Abstract

Background: We report a novel reconstruction technique that maintained effective swallowing after total glossolaryngectomy (TGL) by restoring pharyngeal constriction using a vascularized vastus lateralis muscle transfer. Methods: A 65-year-old male with recurrent tongue cancer underwent TGL and anterolateral thigh flap reconstruction with the vastus lateralis muscle. The bilateral cut ends of the remaining posterior pharyngeal wall constrictor muscle were sutured to the transferred vastus lateralis muscle so that the two muscles encircled the reconstructed pharynx. The femoral nerve of the vastus lateralis muscle was coapted to the hypoglossal nerve. Results: Videofluorographic examination showed the contrast bolus flowing smoothly with little assistance from gravity. Laryngoscopic examination showed circumferential constriction of the reconstructed pharynx. The patient could swallow soft food without placing the bolus in his posterior oral cavity or drinking simultaneously. Conclusion: The restoration of pharyngeal constriction introduces the possibility of functional swallowing in patients after TGL. K E Y W O R D S anterolateral thigh flap, functional swallowing, pharyngeal constrictor muscle, total glossolaryngectomy, vastus lateralis muscle transfer

Analysis of reconstructed oropharynx shape after total glossolaryngectomy reconstruction using a free rectus abdominis musculocutaneous flap

“…In all cases, we aimed to achieve a ‘protuberant oropharynx shape’ using a RAM free flap, as this is generally locally believed to be the ideal configuration for the reconstructed tongue following simple glossectomy. 13 However, we could not achieve this shape in any of our patients, likely owing to the additional resection of the larynx, which would have otherwise functioned as a base for the flap, and the difficulty in obtaining sufficient flap thickness and volume in patients with a low BMI. Consequently, 10 patients had a flat oropharynx and 6 had a funnel-shaped oropharynx.…”

“…Despite the lack of a protuberant oropharynx shape in any of our patients, 81.3% could resume oral feeding 6 months after surgery, which is relatively consistent with the reported rates of 20-89% in the literature. 11 , 13 , 14 , 15 This may be attributed to the sufficient residual post-operative oropharyngeal posterior wall function, as there was no noticeable nasopharyngeal or oropharyngeal closure insufficiency. Although not statistically significant, older age and post-operative radiotherapy showed a trend towards association with non-oral intake, possibly due to impaired residual posterior pharyngeal wall function secondary to irradiation.…”

“…On the contrary, a funnel-shaped reconstruction may be easier to achieve surgically and may help prevent stenosis, 5 but it often requires a feeding tube and may limit patients to a liquid or soft diet. 5 , 13 …”

“Videofluorographic analysis of swallowing function after total glossolaryngectomy.”

“…As demonstrated in our preliminary report, a dynamic muscle transfer to strengthen pharyngeal constriction may lead to excellent clearance and easy oral intake. 7…”

Colgajo libre de peroné para reconstrucción cervical y de pared faríngea tras resección de cordoma

“…En el caso de reconstrucción de pared faríngea posterior secundaria a gloso-laringectomía, ha demostrado ser útil y proveer a los pacientes de una adecuada deglución. (20). No obstante, en nuestro caso en particular, no hubiera sido de utilidad dado que era necesario además reconstruir la región ósea cervical.…”