[Reconstruction after extended partial laryngeal and hypopharyngeal resections. A new method with rib cartilage, chondrosynthesis and free radial transplants].
Partial pharyngectomy combined with subtotal laryngectomy results in permanent tracheostomy and long lasting swallowing difficulties in many cases. Based on our prior experimental and clinical studies on laryngeal chondrosynthesis the objectives of this project were to develop a method for reconstruction of up to two thirds of the larynx and one pyriform sinus.


METHODS
The resected laryngeal framework is reconstructed with autogenous rib cartilage and stabilized with plates and screws. In addition a piece of cartilage is used as a buttress for apposition by the remaining mobile vocal cord. A free radial forearm flap covers the reconstructed framework and forms the sulcus of the pyriform sinus.


RESULTS
Up to now 7 patients have been operated with this technique. The follow up was 35 months on average. None of the patients has a clinically relevant aspiration. All patients have a well understandable voice and one of them--a teacher--could even resume his speech profession.


CONCLUSIONS
In selected patients these techniques enable functional rehabilitation of swallowing, breathing and speech even after extended partial pharyngolaryngectomy.
Siegert
R
R
Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Prosper-Hospital, Akademisches Lehrkrankenhaus der Ruhr-Universität Bochum, Recklinghausen. profsiegert@web.de
Witte
J
J
Jurk
V
V
Kunisch
M
M
Katzbach
R
R
Remmert
S
S
D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002356:Cartilage / Q000637:transplantation*; D002813:Chondrosarcoma / Q000473:pathology / Q000601:surgery*; D003680:Deglutition Disorders / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007013:Hypopharynx / Q000473:pathology / Q000601:surgery*; D007817:Laryngeal Cartilages / Q000473:pathology / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011015:Pneumonia, Aspiration / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D013524:Surgical Flaps; D013957:Thyroid Cartilage / Q000473:pathology / Q000601:surgery; D014827:Vocal Cords / Q000601:surgery