Microvascular Flap Reconstruction of Major Pharyngeal Resections With the Intent of Laryngeal Preservation | Gastroenterology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Article
August 17, 2009

Microvascular Flap Reconstruction of Major Pharyngeal Resections With the Intent of Laryngeal Preservation

Author Affiliations

Author Affiliations: Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas (Dr Sumer); Division of Plastic Surgery and Department of Otolaryngology, University of Maryland, Baltimore (Dr Gastman); and Department of Otolaryngology–Head and Neck Surgery (Drs Nussenbaum and Haughey) and Division of Biostatistics (Dr Gao), Washington University School of Medicine, St Louis, Missouri.

Arch Otolaryngol Head Neck Surg. 2009;135(8):801-806. doi:10.1001/archoto.2009.84

Objective  To determine the functional outcome in patients undergoing pharyngeal reconstruction with free tissue transfer with the intent of functional laryngeal preservation.

Design  Retrospective medical record review.

Setting  Academic tertiary care hospital.

Patients  The study population comprised 45 patients who underwent a major pharyngeal resection with or without a partial laryngeal resection (2 patients died perioperatively, leaving 43 to evaluate). The majority (n = 35 [81%]) had advanced (T3 or T4) primary tumors at presentation and underwent subsequent reconstruction using free tissue transfer at a tertiary care hospital.

Main Outcome Measures  The rate of functional larynx preservation, best swallow score based on the Functional Outcome Swallowing Scale, and need for tracheostomy. Thirteen independent variables relevant to function and 6 postoperative outcome variables were studied following treatment, and their correlation with laryngeal function was determined.

Results  Of the 43 patients, 35 (81%) had T3 (n = 9) or T4 (n = 26) squamous cell carcinoma at presentation. There was 100% flap survival. Thirty-one patients (72%) tolerated an oral diet, with 24 (56%) achieving an exclusively oral diet. Only a history of gastroesophageal reflux disease had a statistically significant correlation with poor swallowing; having had a cranial nerve removed did not achieve statistical significance (P = .06). The majority of patients had their best swallow by 10 months. Of the 43 patients, 42 (97%) achieved native laryngeal speech and 36 (84%) were decannulated. The need for a tracheostomy did not correlate with any of the preoperative independent variables.

Conclusions  Free tissue transfer allows for successful reconstruction of complex pharyngeal defects that functionally threaten the remaining larynx. In properly selected patients, functional laryngeal preservation, decannulation, and use of laryngeal speech can be reliably achieved. Excellent swallowing function can less reliably be predicted.