Remaining laryngeal flap reconstruction of the hypopharynx in pyriform sinus carcinoma resection

Objective: To discuss the feasibility of using remaining laryngeal flap to reconstruct the hypopharyngeal defect in pyriform sinus carcinoma resection.

Methods: Seven patients with pyriform sinus carcinoma to reconstruct hypopharyngeal defect with remaining laryngeal flap were summarized. Half the hypopharynx and half the larynx were resected and unaffected half the larynx was reserved. On the unaffected side, thyroid, cricoid and arytenoid cartilages were removed and inner perichondrium was reserved. A 4.0 cm x 2.0 cm laryngeal flap was made with a broad base on the base of tongue. Subhyoid muscles on unaffected side were reserved and superior laryngeal artery should not be injuries. The food canal was reconstructed with the pulled-down mucosa of the base of the tongue, the unaffected half of the larynx and the remnant hypopharyngeal mucosa. Postoperative radiation (60 Gy) was undertaken.

Results: Six cases healed normally. Local infection and pharyngeal fistula were found in one case and cured in two weeks. No hypopharyngeal stenosis was observed. Through three to five years follow-up of the seven patients, three died in three years and one died in four years.

Conclusions: To the selected cases with pyriform sinus carcinoma, reconstruction of hypopharyngeal defect with laryngeal flap is simple and safe. The injury is relatively small and complications are not severe. In the case sufficient blood supply is insured, firm suture is the key point to prevent pharyngeal fistula.