Salvage Total Laryngectomy Swallowing Outcomes Based on Flap Reconstruction: Onlay vs Incorporated Technique

Abstract

After a salvage total laryngectomy, one of patients’ primary goals is to resume oral intake. This retrospective chart review included all patients who underwent a salvage total laryngectomy with free or pedicled flap reconstruction to compare swallowing outcomes in those with an incorporated flap or primary pharyngeal closure with an onlay flap. There was no significant difference in the ability to achieve complete feeding tube independence or the time that it took to achieve independence. Patients with an onlay flap had significantly lower rates of subjective dysphagia and stricture as compared with patients with incorporated flaps. Incorporated fasciocutaneous flaps showed no significant difference from onlay flaps in terms of outcomes. However, incorporated musculocutaneous flaps showed higher rates of subjective dysphagia and stricture when compared with onlay flaps. Patients undergoing a salvage total laryngectomy and reconstruction with an onlay flap had significantly less postoperative dysphagia and stricture than patients with a musculocutaneous incorporated flap.

Outcome Comparison of Functional Laryngectomy for the Dysfunctional Larynx to Salvage Laryngectomy

“…Of those requiring dilation for stricture, only two patients were not able to achieve total oral intake after dilation, both in the SL cohort. This is in line with other published studies with rates ranging from 23.7 to 26.3% 27–29 …”

“…This is in line with other published studies with rates ranging from 23.7 to 26.3%. [27][28][29] Regaining the ability to take nutrition orally is a paramount goal following TL. The rate of total oral diet achievement in post-radiated TL patients that have undergone MVFTT is reported to range between 55 and 81%, 20,27,29,30 and our data shows a similar rate at 81%.…”

Institutional experience with total pharyngectomy reconstruction: Exploring the role of the salivary bypass tube

“…[18][19][20] A previous study by our team included 59 TL patients with at least 3 cm of pharyngeal mucosa spared, and the overall PCF rate was only 23.7% after reconstruction using either a pedicled flap or free flap. 21 While we showed a lower incidence of PCF in patients with SBTs placed versus those without (42% vs. 71%), this difference did not reach statistical significance ( p = 0.107). A post hoc power analysis showed our study to be underpowered to detect significant difference of this magnitude, with a power (1-β) of 0.37.…”

“…Indeed, it is well‐documented that extended pharyngeal resection predisposes patients to PCF formation 18–20 . A previous study by our team included 59 TL patients with at least 3 cm of pharyngeal mucosa spared, and the overall PCF rate was only 23.7% after reconstruction using either a pedicled flap or free flap 21 …”

Neopharyngeal Stricture following Laryngectomy

“…These onlay flaps have been studied mainly in the context of salvage laryngectomy (SL), and have been shown to provide significantly lower ( p < 0.05) PCF rates when compared with primary or patch closure. 17 18 19 Similar to primary closure, use of an onlay flap has been observed to have significantly higher rates of dysphagia and stricture formation when compared with patch closure. 20 21 There are little data examining differences in stricture rates in patients closed primarily versus those with onlay flaps.…”