Total Hypopharyngeal Reconstruction
PI CHIT SITTITRAI, M.D.*,
THIENCHAI PATTARASAKULCHAI, M.D.*
Affiliation : *Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
AbstractIn advanced hypopharyngeal carcinoma, the tumor may involve the entire hypopharyn
geal mucosa and the larynx. After total laryngohypopharyngectomy is done, reconstruction of
the circumferential defect of the hypopharynx is a challenge. We described our results of using
a myomucosal tongue flap with dermal or skin graft (MTF) in 8 patients and using a tubed
pectoralis major myocutaneous flap (TPMF) in 10 patients to reconstruct the total hypopharynx.
There was no operative mortality. Fistula formation occurred in 3 patients of the MTF group
and 4 in the TPMF group but all had spontaneous healing after conservative treatment. One
in the MTF group and 4 in the TPMF group had stenosis of the anastomotic sites. Almost all
responded well with periodic dilatation. Only one patient in the TPMF group who had been
previously irradiated required gastrostomy for feeding. The 5-year actuarial survival rate of our
patients was 32 per cent.
These results show that total hypopharynx can be reconstructed with the above noted
procedures. The survival rate is good, the morbidity rate is acceptable, and the perioperative
mortality rate is zero.
Keywords : Carcinoma, Hypopharynx, Total Hypopharyngeal Reconstruction, Myomucosal
Tongue Flap, Tubed Pectoralis Major Myocutaneous Flap
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