Epiglottoplasty for reconstruction of defects after laryngectomy with partial pharyngectomy. 2010

Igor Fajdiga, and Ales Groselj, and Avgust Zupevc
University Clinic for Otorhinolaryngology and Cervicofacial Surgery, Zaloska 2, 1000 Ljubljana, Slovenia.

OBJECTIVE We present a novel use of sliding epiglottoplasty as an alternative method for closing mucosal defects in selected laryngectomies with partial pharyngectomy. METHODS Sliding epiglottoplasty as described and advocated by Sedlacek, Bouche, Kambic, and Tucker for reconstruction in partial laryngectomies was used to close the defects after laryngectomy with partial pharyngectomy in 17 patients with advanced hypopharyngeal cancers as primary therapy (16 patients) and as post-radiochemotherapy therapy (1 patient). RESULTS All reconstructions were successful. Primary closures were achieved without additional morbidity, there were no pharyngocutaneous fistulas, and all patients resumed deglutition. Ten patients acquired esophageal speech, speech valves were inserted in 5 cases, and 2 patients required the use of an electrolarynx. CONCLUSIONS If the oncological circumstances allow its preservation in laryngectomy with partial pharyngectomy, the epiglottis is an ideal structure for closing the defect; it is a local tissue with shape, thickness, rigidity, and borders that match the recipient site. In comparison to distant pedicled or free microvascular flaps, the epiglottoplasty is a shorter procedure, requires a smaller surgical team, results in less trauma, has a lower incidence of complications, and enables faster recovery. It is surprising that this elegant, successful, and generally accepted larynx preservation procedure has not been recognized as useful for larger reconstructions.

UI MeSH Term Description Entries
D007012 Hypopharyngeal Neoplasms Tumors or cancer of the HYPOPHARYNX. Hypopharyngeal Cancer,Neoplasms, Hypopharyngeal,Cancer, Hypopharyngeal,Cancers, Hypopharyngeal,Hypopharyngeal Cancers,Hypopharyngeal Neoplasm,Neoplasm, Hypopharyngeal
D007825 Laryngectomy Total or partial excision of the larynx. Laryngectomies
D007831 Larynx, Artificial A device, activated electronically or by expired pulmonary air, which simulates laryngeal activity and enables a laryngectomized person to speak. Examples of the pneumatic mechanical device are the Tokyo and Van Hunen artificial larynges. Electronic devices include the Western Electric electrolarynx, Tait oral vibrator, Cooper-Rand electrolarynx and the Ticchioni pipe. Artificial Larynx,Laryngeal Prosthesis,Voice Prosthesis,Artificial Larynges,Laryngeal Prostheses,Larynges, Artificial,Prostheses, Laryngeal,Prostheses, Voice,Prosthesis, Laryngeal,Prosthesis, Voice,Voice Prostheses
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009367 Neoplasm Staging Methods which attempt to express in replicable terms the extent of the neoplasm in the patient. Cancer Staging,Staging, Neoplasm,Tumor Staging,TNM Classification,TNM Staging,TNM Staging System,Classification, TNM,Classifications, TNM,Staging System, TNM,Staging Systems, TNM,Staging, Cancer,Staging, TNM,Staging, Tumor,System, TNM Staging,Systems, TNM Staging,TNM Classifications,TNM Staging Systems
D010611 Pharyngectomy Surgical removal of a part of the pharynx. (Dorland, 28th ed) Pharyngectomies
D003131 Combined Modality Therapy The treatment of a disease or condition by several different means simultaneously or sequentially. Chemoimmunotherapy, RADIOIMMUNOTHERAPY, chemoradiotherapy, cryochemotherapy, and SALVAGE THERAPY are seen most frequently, but their combinations with each other and surgery are also used. Multimodal Treatment,Therapy, Combined Modality,Combined Modality Therapies,Modality Therapies, Combined,Modality Therapy, Combined,Multimodal Treatments,Therapies, Combined Modality,Treatment, Multimodal,Treatments, Multimodal
D004825 Epiglottis A thin leaf-shaped cartilage that is covered with LARYNGEAL MUCOSA and situated posterior to the root of the tongue and HYOID BONE. During swallowing, the epiglottis folds back over the larynx inlet thus prevents foods from entering the airway. Epiglottic Cartilage,Cartilage, Epiglottic,Cartilages, Epiglottic,Epiglottic Cartilages
D005260 Female Females

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