RECONSTRUCTION OF THE LARYNGOPHARYNX AFTER HEMICRICOID HEMITHYROID CARTILAGE RESECTION - PRELIMINARY FUNCTIONAL RESULTS/

Objective: To evaluate the use of a sensate radial forearm free flap a nd free cartilage graft for reconstruction of the laryngopharyngeal de fect that results from resection of pyriform sinus carcinoma that exte nds to the apex of the pyriform sinus and includes the hemithyroid and hemicricoid cartilages. Design: Case series review of 6 patients trea ted during a 2 1/2-year period with an average follow-up of 23 months. Factors evaluated included oncologic outcome, as well as functional o utcome with regard to the onset and quality of the airway, speech, and deglutition. Setting: Mount Sinai School of Medicine, New York, NY, a n academic, tertiary referral center. Patients: Six men ranging in age from 51 to 73 years underwent a partial laryngopharyngectomy that inc luded the hemicricoid and hemithyroid cartilages as well as the ipsila teral thyroid lobe and either unilateral or bilateral lymph node disse ctions for squamous cell cancer that involved the apex of the pyriform sinus. Intervention: These extensive laryngopharyngeal defects were r econstructed with a sensate radial forearm flap that resurfaced the en dolarynx, restored the depth of the pyriform sinus, and reconstructed the remainder of the hypopharynx. In the final 4 patients, a free cost al cartilage graft was used to restore the infrastructure of the laryn x. Outcome Measures: The status of the margins, the incidence and site of recurrent cancer, the quality of speech, and the times to decannul ation and removal of the gastrostomy tube. Results: Three recurrences developed, with 1 each at the primary site, in the neck, and systemica lly. All but 1 patient who had completed radiotherapy by the last foll ow-up had been decannulated, and all but 1 patient regained the abilit y to maintain nutrition by mouth. Complications were limited to pharyn gocutaneous fistulae requiring surgical closure in 3 patients early in the series. Conclusion: Functional reconstruction of extensive laryng opharyngeal defects can be achieved with a sensate radial forearm flap and a cartilage graft, with favorable functional results and acceptab le morbidity, thus expanding the limits of conservation laryngopharyng eal surgery.