Reconstruction of the hypopharynx after partial laryngopharyngectomy

Recently, larynx-preserving surgery for advanced hypopharyngeal cancer involving the larynx is being performed more frequently. But reconstruction after partial laryngopharyngectomy is still a challenging problem because of postoperative aspiration. In this report, details of our method of laryngopharyngeal reconstruction using a radial forearm flap are described. From 1996 to 2001, 10 patients with hypopharyngeal cancer involving the larynx received partial laryngopharyngectomy at the National Cancer Center Hospital East. The laryngopharyngeal defect was reconstructed using a radial forearm flap in all patients and postoperative laryngopharyngeal function was evaluated. All radial forearm flaps were transferred successfully except in one case. All of the patients achieved satisfactory swallowing function, and all but 1 patient had been decannulated. Postoperative conversational function was rated as excellent by Hirose's scoring system in all patients. A free jejunum transfer is the first choice for reconstruction of a defect after partial hypopharyngectomy. However, it is difficult to reconstruct the supracrycoid complex structure of larynx using a free jejunal graft after partial laryngopharyngectomy. In such cases, we perform functional reconstruction of the laryngopharyngeal defect using a radial forearm flap after which satisfactory postoperative function was achieved. We believe that the key to successful functional reconstruction after partial laryngopharyngectomy is to establish the 3-dimensional complex structure of the arytenoid and aryepiglottic fold.