Our Summary

This research study looks into a common complication that occurs after major surgery on the throat and voice box, where a hole (pharyngostoma) forms between the throat and skin. This can cause problems with swallowing and frequent chest infections. The study involved 15 patients and aimed to examine the best way to fix this issue surgically.

The researchers found that the best time to perform the repair surgery varied between one and three years after the initial surgery, depending on how serious the symptoms were and whether non-surgical treatments had failed.

The corrective surgery mainly involved using a flap of muscle from the chest (pectoralis major myocutaneous flap) and this was done in 11 of the cases. In the remaining four cases, they used flaps from the forearm or thigh.

After the surgery, most patients were able to start eating soft food between 15 and 20 days later. There were a few complications, including wound separation and leaks, and one case of rupture of the carotid artery.

Overall, the researchers concluded that using a flap from the chest muscle is the best way to fix this problem after surgery and radiation treatment on the throat and voice box. However, in cases where there is significant tissue damage from radiation, flaps from other parts of the body may be better. The main goals of the surgery are to cover large blood vessels in the neck, fix the digestive tract, and restore swallowing function, while avoiding further swallowing difficulties and narrowing of the throat.

FAQs

  1. What is the most common complication after major hypopharyngeal and laryngeal ablative surgery?
  2. What is the gold standard for pharyngostoma reconstruction after laryngectomy and cervical radiotherapy?
  3. What complications may occur after pharyngostoma reconstruction?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laryngectomy is to follow post-operative care instructions carefully to prevent complications such as pharyngocutaneous fistula or pharyngostoma. It is important to attend all follow-up appointments and communicate any concerns or symptoms to your healthcare provider promptly. Additionally, maintaining good oral hygiene and staying well-hydrated can help promote healing and prevent infections.

Suitable For

Patients who are typically recommended for laryngectomy are those with advanced laryngeal or hypopharyngeal cancer that cannot be treated with other methods such as chemotherapy or radiation therapy. These patients may have difficulty swallowing, frequent aspiration pneumonia, or other complications that require the removal of the larynx. Additionally, patients who have failed conservative rehabilitation methods for pharyngostoma caused by previous laryngectomy and radiotherapy may also be recommended for this procedure.

Timeline

Before laryngectomy:

  • Patient is diagnosed with cancer of the larynx
  • Patient undergoes various tests and consultations to determine the best course of treatment
  • Patient may undergo chemotherapy and/or radiation therapy before surgery
  • Patient prepares for surgery and receives pre-operative instructions

After laryngectomy:

  • Patient undergoes surgery to remove the larynx
  • Patient may experience pain, swelling, and difficulty swallowing immediately after surgery
  • Patient is monitored closely for any complications, including pharyngocutaneous fistula or pharyngostoma
  • If pharyngostoma occurs, patient may undergo reconstruction surgery, such as with a pectoralis major myocutaneous flap
  • Patient undergoes post-operative care and rehabilitation to regain swallowing function and adjust to life without a larynx

What to Ask Your Doctor

  1. What is a laryngectomy and why is it necessary in my case?
  2. What are the potential complications of laryngectomy surgery?
  3. What is a pharyngostoma and how does it occur after laryngectomy?
  4. What are the symptoms of pharyngostoma and how is it typically treated?
  5. What is the process for pharyngeal reconstruction after laryngectomy and radiotherapy?
  6. What are the different reconstruction methods available and how do they differ in terms of outcomes and complications?
  7. What is the typical recovery time after pharyngeal reconstruction surgery?
  8. What are the potential risks and complications associated with pharyngeal reconstruction surgery?
  9. How will pharyngeal reconstruction surgery affect my ability to swallow and eat?
  10. What follow-up care will be needed after pharyngeal reconstruction surgery?

Reference

Authors: Bini A, Katsaros K, Stavrianos S. Journal: J Plast Reconstr Aesthet Surg. 2024 Dec;99:543-550. doi: 10.1016/j.bjps.2024.10.019. Epub 2024 Oct 16. PMID: 39489060