Free-flap reconstruction for laryngeal preservation after partial laryngectomy in patients with extended tumors of the oropharynx and hypopharynx

Partial laryngeal resection often results in major aspiration problems, mak ing larynx preservation during surgical removal of tumors of the oropharynx and hypopharynx impossible. However, free flaps can be used to reconstruct perilaryngeal tissue, thus preserving the larynx and ensuring a better qua lity of life for patients. The present the results of forearm free-flap rec onstruction of the supraglottis in 22 patients who underwent resections of extended squamous cell carcinomas of the oropharynx and hypopharynx. A tota l of 9 patients had T3 lesions and 13 had T4 lesions. All patients were add itionally treated with radiation therapy alone (to 70 Gy) or in combination with chemotherapy (Cisplatin; 5-fluorouracil). The mean follow-up was 2.4 years. In four patients, tracheostomy could be closed. Five patients suffer ed from severe aspiration, one of whom had to undergo a laryngectomy. Six p atients had mild aspiration and 7 patients had no aspiration, but extensive edema made decanulation impossible. A total of 13 patients were free of di sease, 4 patients died of disease, 1 patient died as the result of a second primary cancer and 1 patient died of other causes. Three patients are aliv e with persistent tumor. Although the majority of patients experienced a be tter quality of life as a result of larynx preservation, aspiration has rem ained a problem following treatment.