Posterior Wall Pharyngectomy with Preservation of Laryngeal Function

Extensive carcinoma of the hypopharynx has traditionally been treated by pharyngolaryngectomy with a wide variety of reconstructive methods. When not involved by tumor, the larynx is sacrificed because of aspiration (resulting from loss of laryngeal nerve and pharyngeal function) and airway obstruction (caused by bulky, crusting, nonmucosal-lined flaps). Teichgraeber and McConneP recommended total or near-total laryngectomy if more than' 4 em of the posterior hypopharyngeal wall was resected. The uninvolved larynx is therefore sacrificed for functional rather than oncologic reasons. If these functional problems are solved, the larynx could be preserved. We present a case of extensive simultaneous carcinoma of the hypopharynx (6 em x 5 em) and oropharynx (4.5 cm x 3 cm), treated with a near-total posterior wall pharyngectomy and extended radical tonsillectomy with preservation of laryngeal function. Reconstruction was accomplished with a free jejunal graft, open on its antimesenteric border to create a "patch" graft. In many ways the free jejunal patch graft is ideal material for the reconstruction of extensive upper aerodigestive tract defects. It is a single-stage procedure which supplies thin, mucosal-lined, radiation-tolerant tissue with a rich blood supply. Although its predecessor, the free jejunal tube graft, has been reported a reliable and preferred technique for reconstruction after pharyngolaryngeal cervical esophagectomy.i" the jejunal patch graft has been less widely reported. 5-8