Reconstruction of the Voice After Laryngectomy

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Head and neck reconstruction is an intensive multistep process that requires attention to detail to achieve a successful result. The knowledge and prevention of complications as well as their management is an essential part of the training of the surgeon participating in head and neck reconstruction. This article explores the general complications, including free flap failure, carotid artery blowout, hardware exposure, and ectropion, as well as regional complications relating to operations of the scalp, cranium, base of skull, midface, mandible, and pharyngoesophagus.KEYWORDS: Free flap failure, carotid blowout, hardware exposure, ectropion, scalp, cranium, base of skull, midface, mandible, pharyngoesophagus Head and neck reconstruction is mainly performed after extirpative oncologic surgery, as well as for trauma, congenital defects, and infection. Head and neck reconstruction can be subdivided into several regions of interest; namely, the scalp and cranium, the base of the skull, the midface, the mandible, and the pharyngoesophagus.The goals of head and neck reconstruction are to restore form, function, and aesthetics by the selection and use of safe techniques. To achieve this, good wound healing has to be accomplished in frequently hostile environments. Use of the reconstructive ladder as a guide for reconstruction is appropriate, especially as most small defects can be closed with local flaps or grafts. However, when there is a large composite defect, free flaps are frequently required to achieve these goals. 1The importance of a free flap is highlighted by the fact that a failed free flap in head and neck reconstruction may necessitate reconstruction with a second or even third free flap.2,3 Success rates for free flaps in the head and neck and upper extremities are high, at around 97 to 98%.3,4 These success rates can be maintained even in the elderly population at 96% as reported by Coskunfirat et al 5 and at 95% as reported by Malata et al. 6 This article will explore the general complications, including free flap failure, carotid artery blowout, hardware exposure, and ectropion, as well as regional complications relating to operations of the scalp,

“…In the authors' experience, jejunal flaps enjoy lower leak rates as mucosa-to-mucosa healing promotes better union at the suture lines. 36 Measures employed to reduce leaks include:…”

Section: Fistulamentioning

confidence: 99%

Section: Stricturementioning

confidence: 99%

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Complications of Head and Neck Reconstruction and Their Treatment

Tan

Por

Chen

2010

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“…Voice function can be reconstructed in addition to regular esophageal reconstruction following total pharyngolaryngectomy (Table 3). 46 There are several options. (1) Conventional voice prosthesis is used, that is, skin flap for esophageal reconstruction, and voice prosthesis for vocal function restoration.…”

Section: Improved Functions After Free Flap Reconstruction (Table 2)mentioning

confidence: 99%

Head and Neck Reconstruction in Trauma and Cancer

2003

It is challenging to perform reconstruction for head and neck regions following trauma or cancer ablation even today. Although microsurgery has improved greatly in the past 50 years, there are still many problems when the defect is large because of the complex functions of the head and neck and the increasing expectation on the part of the patients. Notable advances in head and neck reconstruction include (1) improvement in flap survival and decreased morbidity of both donor sites and recipient sites, (2) capacity of reconstruction for complex defects, (3) improvement in functions through intimate cooperation among ENT, neurosurgery, dentistry, and plastic surgery, (4) improvement in aesthetic result especially in facial reconstruction, (5) application to new fields such as tracheal reconstruction and voice reconstruction with a segment of jejunum or ileocolon, (6) creation of new flaps, and (7) tissue engineering and transplantation, which are still under investigation. The results of free flaps have been more and more controllable. Treatment has become centered on the patient and his disease instead of a flap-oriented approach. For head and neck reconstruction free flaps have been used in critical areas such as the skull base. They will be even more widely used in the future. Longer survival after cancer ablation and reconstruction is also contributed to by improved chemotherapy, radiotherapy, and other specialties.

“…When there is a need for simultaneous reconstruction of the esophagus and voice, proper autogenous tissue should be selected to achieve these goals in one setting while preventing reflux of food into the airway. 41 When the midface or mandible are reconstructed, a platform for the oral cavity and midface should be restored and the central nervous system must be separated from the oral cavity and paranasal sinuses. The midface also plays an important role in speech and swallowing and should be reconstructed with an appreciation of this role.…”

Section: Goal Of the Reconstructionmentioning

confidence: 99%

General Principles and Analysis of Defects in Head and Neck Reconstruction

2003

The challenging task of reconstructing head and neck defects can be performed nowadays with good results and high success rates. This field has developed significantly with the introduction of microsurgical techniques, where in one stage complex composite defects can be reconstructed. An appreciation of the physiologic and morphologic loss occurring as a result of defect creation, appropriate preoperative planning, individualized assessment and care, and multidisciplinary cooperation all can aid in optimizing the final outcome. In this review article, these issues, as well as the effects of radiation therapy on the reconstructive plan, the appropriate choice of vessels during the reconstruction, and the use of multiple flaps and their indications, are discussed. Results achieved today are a testament to the advancements in the field of reconstructive microsurgery, where both functional and aesthetic goals are met.