Pharyngeal reconstruction after total laryngectomy: options in a developing country.

Abstract

Objectives: To discuss various pharyngeal reconstructive methods following total laryngectomy in a Nigerian tertiary health institution.
Materials and methods: This is a review of all pharyngeal reconstruction methods carried out following total laryngectomy in patients with histologically confirmed laryngeal cancer over a nine year period from
November 1999- July 2007 at Usmanu Danfodiyo University Teaching Hospital, Sokoto.
Results: A total number of 33 patients were histologically confirmed to be squamous cell carcinoma. Seventy two percent were T4 lesions from the AJC classification of tumors requiring total laryngectomy. Only 15
(62.5%) patients accepted to undergo total laryngectomy. Pharyngeal reconstructive methods carried out were: direct mucosal closure using the residual mucosa in 12 patients, full Skin thickness skin graft in three
cases and musculo-cutaneous (pectoralis major) flap in one case. Pharyngeal stenosis was the commonest complication following full skin thickness graft within three months of surgery. Direct mucosa closure proved to be superior if it was done properly, when the mucosa was adequate, than all other methods. However when the mucosa was not adequate, musculo-cutaneous flap proved to be better than full thickness skin graft. Pharyngocutaneous fistula occurred only in all cases of full thickness skin graft that was due to residual tumour but closed on conservative management of nil oral and nasogastric tube feeding.
Conclusion: Pharyngeal reconstruction after total laryngectomy varies depending on the operative findings, the medical status of the patient, the predisposition of the surgeon and the facilities available at that point to
handle them.

Keywords: total laryngectomy, pharyngeal reconstruction, pectoralis major
musculo-cutaneous flap