PRIMARY CLOSURE OF PHARYNGEAL REMNANT AFTER TOTAL LARYNGECTOMY AND PARTIAL PHARYNGECTOMY - HOW MUCH RESIDUAL MUCOSA IS SUFFICIENT

After total laryngectomy with or without partial pharyngectomy, the re maining pharyngeal defect can be repaired either by primary closure or with additional tissue, depending on the amount of pharyngeal tissue remnant available, The aim of this study was to determine the minimum width of tile pharyngeal remnant that could. be safely closed primaril y without causing difficulty in swallowing. A total of 52 consecutive patients who underwent total laryngectomy were entered into the study. The relaxed and stretched widths of tile pharyngeal remnant were meas ured after removal of the specimen, The widths of Che pharyngeal mucos a ranged from 1.5 to 5.0 cm relaxed (mean, 3.24 cm) and from 2.5 to 8. 0 cm stretched (mean, 3.24 cm), All neopharynx was reconstructed by cl osing the pharynx primarily. Seven of the 52 patients developed recurr ent tumor with concomitant dysphagia. Two Of the 45 patients without r ecurrence presented with acute dysphagia from food bolus obstruction, and 1 patient developed benign inflammatory stricture following an epi sode of fish-bone impaction. The narrowest widths of tile pharyngeal r emnant in this group of 45 were 1.5 cm relaxed and 2.5 cm stretched. A s these patients do not have swallowing difficulty, we conclude that i n the absence of tumor recurrence, this remount of residual pharyngeal tissue is sufficient both for primary closure of the pharynx and in r estoring swallowing function.