title: Atypical reconstructions with free jejunum flap after circumferential pharyngolaryngectomy.
abstract: The ideal reconstruction after circumferential pharyngolaryngectomy is represented by the jejunum free flap, but when the resection extends to the oro- or nasopharynx, the discrepancy between the lumen of the flap and the pharyngeal defect represents a disadvantage. Two reconstructions to overcome this problem are presented: end-to-side anastomosis between the pharynx and the antimesenteric side of the jejunum; and a jejunal "reservoir." The type 1 technique is quicker to perform, but can result in dysphagia; the type 2 technique is more complex, but usually no dysphagia is observed. In our opinion, no ideal surgical technique exists to equal the jejunum loop. The choice must be tailored to the single patient, bearing in mind the degree of the defect, the stage of the tumor removed, the general conditions of the patient, and personal surgical experience. Whatever procedure is chosen, it should provide the best possible quality of life for the expected life span of the patient.
authors.affiliation: Department of Otolaryngology Head Neck Surgery, University of Pavia, I.R.C.C.S. Policlinico S. Matteo, Piazzale Golgi 2, Pavia 27100, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Benazzo
authors.forename: Giulia
authors.initials: G
authors.lastname: Bertino
authors.forename: Patrizia
authors.initials: P
authors.lastname: Gatti
authors.forename: Mario
authors.initials: M
authors.lastname: Alessiani
authors.forename: Antonio
authors.initials: A
authors.lastname: Occhini
authors.forename: Roberto
authors.initials: R
authors.lastname: Spasiano
mesh_terms: D000714:Anastomosis, Surgical; D004947:Esophagus / Q000601:surgery; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007583:Jejunum / Q000601:surgery; D007825:Laryngectomy; D010611:Pharyngectomy; D010614:Pharynx / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps