Improvement of Functional and Aesthetic Results for Patients after Creation of Diversion Loop for Cervical Esophagus-Case Report

Abstract

Choking is a serious problem in pharyngoesophageal reconstruction. These patients have to make a choice between preservation of vocal function but using permanent jejunostomy for feeding, and oral intake but using permanent tracheostomy for breathing. For patients who had chocking from previous injury to epiglottis, a new solution is creation of a diversion loop which allows food to pass from the oral vestibule to cervical esophagus. However, there is a disadvantage of the diversion loop. Because the jejunal flap was placed at subcutaneous layer, the patients may complain of the disfigurement due to the bulging of the chin. When the patients who received this procedure of diversionary loop had established good swallowing function, and they complained the disfigurement of the bulging of the chin, these patients are evaluated, including the mandible X-ray which is used to make sure the position of the tooth buds. A transverse skin incision is made for exploration of the mandibular tubercle, which is then trimmed off about 0.7~1 cm in height and 2 cm in width. The neck scar is also revised with multiple Z-plasties. Significant improvement in the function and aesthetic results was achieved. This is revealed on psychological interview. After removal of the mandibular margin some patients even got improvement in the speed of swallowing as revealed by dynamic esophagogram. The marginal mandibulectomy further contributed to the value of the diversion loop method, especially for young female patients.