COMPUTER MANOMETRY IN SITE-RELATED RECONS TRUCTION OF THE PHARYNX ANDPHARYNGOESOPHAGEAL SEGMENT

Fifty-three patients who underwent laryngopharyngeal cancer surgery we re examined with a sequential computer manometry system using 4-channe l pressure probes. Swallowing coordination is largely independent of t he oropharyngeal pressure thrust nor of the pharyngeal transit time an d depends mainly on initiation of swallowing. The points of interest a re the pharyngeal entrance and outlet. The topographic correlates are the base of the tongue and the upper esophageal sphincher. Resections of the base of the tongue decrease the volume available for pressure g eneration reducing the driving force of the tongue. Thus, reconstructi on at the base of the tongue must provide more bulky-tissue coverage ( i.e. myocutaneous flaps) in order to avoid cranial release of pressure and to bring about initiation of swallowing. Resections of the pharyn goesophageal segment cause circular defects that affect the sphincter, reducing hypopharyngeal suction. Thus, the resistance to bolus flow i s generally increased, but can be compensated for by an increased driv ing force of the tongue. Additional pharyngeal and/or lingual resectio ns increase the lumen discontinuity between the wide pharynx and the n arrow esophagus, exceeding any compensatory possibilities. Plastic rec onstructions therefore have to compensate for different lumina distall y. In the region of the upper esophageal sphincter, softer and smoothe r tissue coverage is warranted in order to facilitate bolus transfer o r passive bolus flow if necessary. For that purpose we modified the my ofascial pectoralis-major-flap. It covers defects where a soft lining is required. The resistance to bolus flow is reduced, alleviating the need to increase the driving force of the tongue which would otherwise increase to compensate for the defect.