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The techniques of nonmuscular closure of hypopharyngeal defect following total laryngectomy: the assessment of complication and pharyngoesophageal segment

Published online by Cambridge University Press:  29 June 2007

Ching-Ping Wang ,
Tzu-Chan Tseng ,
Rheun-Chuan Lee  and
Shyue-Yih Chang
Ching-Ping Wang
Affiliation:
Department of Otolaryngology, Veterans General Hospital, National Yang Ming University, Taipei, Taiwan
Tzu-Chan Tseng
Affiliation:
Department of Otolaryngology, Veterans General Hospital, National Yang Ming University, Taipei, Taiwan
Rheun-Chuan Lee
Affiliation:
Department of Radiology, Veterans General Hospital, National Yang Ming University, Taipei, Taiwan
Shyue-Yih Chang*
Affiliation:
Department of Otolaryngology, Veterans General Hospital, National Yang Ming University, Taipei, Taiwan
*
Address for correspondence: Shyue-Yih Chang, M.D., Department of Otolaryngology, Veterans General Hospital, Taipei, Taiwan. Fax: 886-2-8757338
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Abstract

The usual method of reconstructing a hypopharyngeal defect during total laryngectomy includes pharyngeal muscle layer closure, which may result in high pharyngoesophageal pressure. We hypothesize that nonclosure of the pharyngeal muscle can reduce the pressure of the pharyngoesophageal segment which can reduce the chances of the formation of pharyngocutaneous fistulae. A technique of nonmuscular closure of a hypopharyngeal defect is presented. The differences in the rate of fistula formation and swallowing function between patients with usual and nonmuscular closure were also studied. Sixty consecutive laryngectomees were enrolled in this study. Thirty patients received usual closure after total laryngectomy, whereas the other 30 patients underwent non closure of their pharyngeal muscles. One patient (3.3 per cent) in the nonmuscular closure group and three patients (10 per cent) in the usual closure group developed a pharyngocutaneous fistula. The pharyngoesophageal pressures of the nonmuscular closure group were significantly lower than those of the usual closure group. We conclude that the technique of nonclosure of the pharyngeal constrictor muscle after total laryngectomy is relatively more simple and is not associated with a higher rate of fistula formation. Furthermore, nonclosure of the pharyngeal constrictor muscle is preferable to muscular closure because it reduces the spasm of the pharyngoesophageal segment which limits voice rehabilitation.

Keywords

Laryngeal neoplasmsSurgery, operativePharyngeal musclesFistula
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 111 , Issue 11 , November 1997 , pp. 1060 - 1063
Copyright
Copyright © JLO (1984) Limited 1997

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