THE TECHNIQUES OF NONMUSCULAR CLOSURE OF HYPOPHARYNGEAL DEFECT FOLLOWING TOTAL LARYNGECTOMY - THE ASSESSMENT OF COMPLICATION AND PHARYNGOESOPHAGEAL SEGMENT

The usual method of reconstructing a hypopharyngeal defect during tota l laryngectomy includes pharyngeal muscle layer closure, which may res ult in high pharyngoesophageal pressure. We hypothesize that nonclosur e of the pharyngeal muscle can reduce the pressure of the pharyngoesop hageal segment which can reduce the chances of the formation of pharyn gocutaneous fistulae. A technique of nonmuscular closure of a hypophar yngeal defect is presented. The differences in the rate of fistula for mation and swallowing function between patients with usual and nonmusc ular closure were also studied. Sixty consecutive laryngectomees were enrolled in this study. Thirty patients received usual closure after t otal laryngectomy, whereas the other 30 patients underwent non closure of their pharyngeal muscles. One patient (3.3 per cent) in the nonmus cular closure group and three patients (10 per cent) in the usual clos ure group developed a pharyngocutaneous fistula. The pharyngoesophagea l pressures of the nonmuscular closure group were significantly lower than those of the usual closure group. We conclude that the technique of nonclosure of the pharyngeal constrictor muscle after total larynge ctomy is relatively more simple and is not associated with a higher ra te of fistula formation. Furthermore, nonclosure of the pharyngeal con strictor muscle is preferable to muscular closure because it reduces t he spasm of the pharyngoesophageal segment which limits voice rehabili tation.