Lateral Pharyngotomy Research Articles

Set-Back Tongue Flap for Carcinoma of the Tongue Base

Carcinoma of the base of the tongue has been treated with various combinations of radiotherapy and surgery. Resection of this area poses a major problem in reconstruction because of the need for establishing normal physiologic characteristics. This article emphasizes the benefits of a lateral pharyngotomy and mandibulotomy for resection of large portions of the tongue base. We describe a tongue flap with a neurovascular pedicle that is set back into the tongue-base deficit. This one-stage procedure is relatively easy to perform and provides good physiologic results.

Benign Pleomorphic Adenoma of the Larynx: A Case Report

Minor salivary gland tumors of the larynx are relatively rare. Morphologically the majority of them are adenoid cystic carcinomas and the overwhelming location is the subglottic larynx. Benign pleomorphic adenomas are rare minor salivary gland tumors of the larynx which usually occur at the glottic and subglottic levels. We present only the sixth case of a supraglottic benign pleomorphic adenoma that we could find in the literature. A preoperative laryngogram localized the tumor to the supraglottic larynx and the intact mucosa suggested a specific differential diagnosis. The tumor was removed by a lateral pharyngotomy with retention of good laryngeal function. The relatively asymptomatic presentation of our case is a somewhat unusual finding which, however, was previously noted in similar case reports.

Lipoma of the larynx

The authors report a case of lipoma of the larynx which was removed successfully through a lateral pharyngotomy approach.

Experiences in lateral pharyngotomy

Lateral pharyngotomy offers good exposure for the removal of many laryngeal and hypopharyngeal tumors. The simplified operation I present avoids damage to voice, deglutition or airway. This approach can be expanded to reach almost any tumor of the pharynx and radical neck dissection can be incorporated. The cosmetic result has been satisfactory, but if individual consideration prompts it, a more horizontal skin-fold incision can easily be substituted.

Esophageal atresia treated by electromagnetic bougienage and subsequent repair

There are some infants with esophageal atresia with or without tracheoesophageal fistula in whom the esophageal segments are too far apart to allow safe primary anastomosis without tension. During the past 20 yr the most widely used approach in these cases has been temporary marsupialization of the blindly ending upper esophagus to the neck, followed later by interposition of a segment of colon. 1 Howard and Myers 2 introduced manual bougienage for the upper pouch to elongate it and accomplish a delayed primary anastomosis. This technique was later used with some success in other institutions. 3 Rehbein 4 placed bougies in both esophageal segments and applied traction sutures threaded through the ends of the pouches that were pulled together slowly. This paper describes another method used in four infants with esophageal atresia. Metal bougies (“bullets”) were placed into the two ends of the esophagus. An electromagnetic field was then used to pull the bullets together to elongate the esophageal ends in order to allow esophageal anastomosis, which had been impossible previously. Cases 1 and 2 were discussed in a previous report 5 and therefore will not be described in as much detail as Cases 3 and 4. Certain refinements in the method were developed in treating Cases 3 and 4. For example: (1) The sump suction tube attached to the upper-pouch bullet was brought out through a lateral pharyngotomy instead of the nose. (2) The stem of the lower-pouch bullet was brought through a small separate stab incision in the midline to direct it straight upward. Leakage around the gastrostomy site proved troublesome when it was brought through the same opening as the gastrostomy tube. (3) The lower-pouch bullet was placed “by feel” into the distal esophagus, not requiring anesthesia. Initially this was done under direct endoscopic visualization using anesthesia. (4) Placing of the lower-pouch bullet, which has a flexible steel stem, was accomplished by sliding a rigid metal tube over the flexible cable, using this as a handle to direct the bullet into the distal esophagus.

Surgery for carcinoma of the posterior pharyngeal wall.

An approach for resection of carcinoma of the posterior hypopharyngeal wall and a method of repair of the pharynx, which was first described by Trotter, are presented. This exposure and repair can be carried out without sacrifice of the larynx in certain selected patients. This technique was used with preoperative irradiation therapy at a tumorcidal dosage to the primary tumor and 5,000 rads to the neck. A lateral pharyngotomy incision is extended horizontally superior to the hyoid bone. The larynx is rotated to the opposite side. The hypopharynx may be resected from the level of the oropharynx to the cricopharyngeus muscle and from one pyriform sinus to the other. Reconstruction is accomplished with a laterally based skin flap in two stages. With this technique, a functioning larynx is preserved, and the continuity of the upper alimentary tract is reestablished.

Repair of hypopharyngeal stenosis.

Stenosis of the hypopharynx is an infrequent but devastating complication in the management of patients following ingestion of caustic solutions. Adequate methods of reconstruction are available for treatment of massive stenoses of the laryngopharynx and esophagus. Minimal involvement is commonly treated by endoscopic techniques. The patient with partial obliteration of the hypopharynx presents a perplexing problem in management. Resection of the stenotic area is best accomplished by combining lateral transthyroid pharyngotomy with reconstruction employing local flaps and a Z-plasty technique.

Lateral pharyngotomy approach for lesions of the base of the tongue, pharynx and larynx.

Lateral pharyngotomy approach for lesions of the base of the tongue, pharynx and larynx.

On the treatment of esophageal diverticula.

A follow up study has been made on 31 patients with hypopharyngeal pouch operated during the years 1951–60 and on 8 patients from the same period which have not been operated. The patients have been interviewed about their symptoms and X-rayed. Of the operated group, six have died of other diseases, twelve are without any complaints, nine have mild and four more pronounced symptoms. One patient concludes that the operation has not made her better. The X-ray findings were not exactly correlated to the symptoms of the patients. In the non-operated group the roentgenograms did not show any increase in size of the smallest diverticulas during a ten-year period. It is concluded that the etiology of hypopharyngeal pouches is unclear, that cases in stage I should be treated conservatively, cases in stage II or III operated by a one stage lateral pharyngotomy with excision of the pouch with or without division of the cricopharyngeal muscle.

Excision of obstructing retropharyngeal tumor in an infant; excision by sagittal jawsplitting approach.

The choice of a surgical approach to the pharynx depends upon the location and size of the lesion under consideration. If primarily located in the oropharynx, a direct transoral approach is usually adequate. The nasopharynx may also be reached through an intraoral approach with or without a softpalate-splitting incision or removal of part of the posterior bony palate. 1 If this is not adequate, a lateral pharyngotomy with or without a transection at about the angle of the mandible 2 may yield a good exposure of the nasopharynx. In certain instances a transantral approach through a Caldwell-Luc or Weber-Fergusson incision may be elected. The hypopharynx may be reached by suspension laryngoscopy or through an anterior 3 or lateral pharyngotomy exposure. Very extensive lesions in these areas, especially those that require complete extirpation with a maximum of safety, challenge the effectiveness of any of these surgical approaches. A situation of this

Laryngoesophagectomy: Primary Closure with Laryngotracheal Autograft

Carcinoma of the postcricoid region involving the mouth of the esophagus and the posterior surface of the larynx is best treated by surgical extirpation. Lateral pharyngotomy, as suggested by Trotter,1with preservation of the larynx is a limited operation with disappointing results and has been abandoned. Radical excision of a segment of the pharynx and the upper portion of the esophagus, together with the whole of the larynx, has more recently been performed. The alternative is the relegation of the patient to a painful and lingering death. Reconstruction of the pharynx after a pharyngoesophagolaryngectomy has heretofore required prolonged hospitalization and extensive plastic repair. The operation suggested by Wookey2provided the posterior surfac of the new esophagus but bipedicle skin flaps were almost invariably required for closure. In many instances a prolonged pharyngostomy, with all its discomforts, was required, and often recurrence of the carcinoma appeared before the final

CANCER OF THE LARYNGOPHARYNX

I am confining my comments to malignant tumor of the laryngopharynx, better known as extrinsic cancer of the larynx, which includes growths in the epiglottis, the aryepiglottic folds, the lateral and the posterior pharyngeal wall, the piriform sinus and the postcricoid region, or, in other words, in the area from the tip of the epiglottis to the opening in the esophagus. This small area is the all too frequent site of malignant tumor at its worst, and to the laryngologist it is the field of the most interesting problems of surgery of the neck. I agree with Beck and Guttman, 1 who stated hypopharyngeal malignancy is not altogether a hopeless condition. If the lesion is seen early, when it is small and localized, ... some hope is present that the patient can be subjected to a successful lateral transthyroid pharyngotomy. The area is not difficult to examine, nor is it

Carcinoma of Pharyngeal Wall Removed by Lateral Pharyngotomy

Carcinoma of Pharyngeal Wall Removed by Lateral Pharyngotomy

Carcinoma of Deep Pharynx Removed by Lateral Pharyngotomy

Carcinoma of Deep Pharynx Removed by Lateral Pharyngotomy

A Method of Lateral Pharyngotomy for the Exposure of Large Growths in the Epilaryngeal Region

A Method of Lateral Pharyngotomy for the Exposure of Large Growths in the Epilaryngeal Region

A Method of Lateral Pharyngotomy for the Exposure of Large Growths of the Epilaryngeal Region.

A Method of Lateral Pharyngotomy for the Exposure of Large Growths of the Epilaryngeal Region.

Scleroma of the Larynx

Scleroma of the Larynx

Specimen of Lymphosarcoma of the Tonsil, Removed by Lateral Pharyngotomy after Vohsen's Method

Specimen of Lymphosarcoma of the Tonsil, Removed by Lateral Pharyngotomy after Vohsen's Method