DYSPHAGIA AFTER PHARYNGOLARYNGEAL CANCER-SURGERY .2. IMPLICATIONS FORRECONSTRUCTIVE PROCEDURES

In the base of the tongue region, reconstructive procedures have to pr ovide more bulky-tissue coverage (i.e., myocutaneous flaps) in order t o avoid cranial release of pressure and to bring about swallowing init iation. Resections of the pharyngoesophageal (PE) segment cause circul ar defects, always affecting the sphincter and necessarily relaxation, thus reducing the hypopharyngeal suction pump. The resistance to bolu s now, therefore, is generally increased but can be compensated by a s tronger tongue driving force. In addition to the functional obstructio n, special attention is called to the growing lumen discontinuity betw een the wide pharynx and the narrow esophagus. Plastic reconstructions , therefore, have to compensate for different lumina distally. Followi ng ablative surgery in the upper esophageal sphincter region, a softer and smoother tissue coverage is warranted in order to facilitate bolu s transfer to a passive bolus flow if necessary. For that purpose, a n ew myofascial pectoralis flap was designed based on morphometric inves tigations and postmortal selective injection studies. In this flap, th e bulky muscle mass is separated from just a vascularized, thin fascia -muscle layer. The donor site is covered with the remaining bulky musc le-skin complex left intact. The fascial flap covers defects where a s oft lining is required and replaces the PE segment as a tubed neophary nx. Histologic specimens show a reepithelization with local mucous mem brane from the anastomotic site to the fascial surface. The resistance to bolus flow is reduced, thus alleviating the tongue driving force, which is increased for compensation in any case.