Pharyngeal Stenosis Research Articles

Comparison of the Outcome of Surgery and Radiotherapy in the Treatment of Early Carcinoma of the Larynx

Background: The most prevalent disease to afflict the head and neck region is laryngeal cancer. The early stage of this disease, T1T2N0M0, has a higher chance of recovery than the other phases. Radiation therapy and surgery are its therapeutic techniques.
 Objective: To Compare the outcome of surgery and radiotherapy in the treatment of early carcinoma of the larynx
 Methods: This cross-sectional study was carried out at tertiary hospital Dhaka from January 2022 to January 2023. Where A total of 200 Patients of carcinoma of the larynx are evaluated properly by detailed history taking, clinical examination and relevant investigation. During the study two groups of patients were dealt separately; Group-1: Surgery using LASER, n=100 and Group-2: radiotherapy, n=200. All the patients were followed up after 2 weeks, 1 month and then three monthly for one year.
 Results: During the study, supraglottis carcinoma was found in 65% of radiotherapy group and 70% in surgery group, glottic carcinoma was 35% & 30%, respectively in radiotherapy and surgery group. No case found with subglottic carcinoma. Where in surgery group 7% patients had haematoma, 5% patients had seroma & pharyngeal stenosis. In radiotherapy group 2.5% Severe radiation necrosis of skin & 3% had Respiratory distress following radiotherapy. . In the radiotherapy group, 25% cases were scored as normal and 45% as good. For the surgery group, 40% patients had good voice and speech, 35%r had moderate voice and speech, and 5% had poor voice and speech. This difference was statistically significant (p=.001). 14% of the irradiation group had a primary site recurrence compared with 20% in the surgery group at 12th months. There was a significant difference in the pattern of recurrence in the neck between the two treatment groups. Only 5% of those who were treated with irradiation had a recurrence in the neck. 14% of patients in the surgery group had a recurrence in the neck; this difference was statistically significant.
 Conclusions: When treating early laryngeal cancer, radiation therapy and surgery are equally successful. However, patients who had radiation therapy had much improved speech and voice quality compared to those who received surgery.

Association between Oral Cancer Surgery and Postoperative Airway Obstruction: A retrospective study

ObjectivePredicting postoperative airway obstruction during oral cancer surgery is difficult. We aimed to investigate the relationship between postoperative airway obstruction and surgery in patients. MethodsPatients (n=100, men: 72, women: 28) with oral malignancies who underwent surgery between January 2020 and December 2022 were included. The outcome was postoperative airway obstruction. Age, sex, alcohol, smoking history, BMI, tumor site, T and N classification, stage, surgical method, lymphatic invasion, vascular invasion, perineural invasion, DOI, airway management, occurrence and duration of postoperative airway obstruction were investigated. We defined airway obstruction as confirmed symptoms such as dyspnoea and wheezing, drop in SpO2 below 90%, stridor auscultation and pharyngeal stenosis by endoscope.The relationship between airway obstruction and patient characteristics was analyzed using Fisher's exact test. The Kaplan–Meier method was used to assess onset of airway obstruction, and the time to onset of airway obstruction was compared using the log-rank test. Airway obstruction and surgery-related factors were evaluated using Cox regression models. ResultsAirway obstruction occurred in 6 patients within 12hours. Multivariate analysis revealed that age >65 years, lymphatic invasion and DOI (cut-off value: 7.00mm) were independent risk factors for occurrence of airway obstruction. ConclusionLocal resection of tumors ≥7mm in DOI is associated with airway obstruction owing to factors such as swelling associated with deep resection. Age, lymphatic invasion are also associated with airway obstruction, requiring ward management according to the protocols of each institution with attention to postoperative hematoma and edema that may cause airway obstruction.

Hypopharyngeal reconstruction using prelaminated autologous bio-engineered pectoralis major flaps

After removal of metastatic malignant tumors of the hypopharynx and larynx, hypopharyngeal defects are formed. To restore the hypopharynx, a mucosa and a muscular component are needed.The objective of this study is to develop a hypopharyngeal reconstruction technique using prelaminated pectoralis major flap with mucosal epithelium analogue from autologous epithelial layers.Materials and methods. Nine patients underwent reconstruction of the hypopharynx using bioengineered prelaminated pectoralis major flaps. The mucosa was restored by tissue-engineered autologous epithelial cell layers that were obtained by culturing in vitro cells isolated from skin biopsies that were previously obtained from patients.Results. Oral nutrition was restored in all cases. Pharyngeal stenosis was detected in one (11%) patient. A stratified squamous epithelium on the pectoral fascia was revealed in 67% of cases at week 2 after prelamination, in 89% of cases at week 4 after reconstruction and in 100% of cases at month 3, 6, 12 and 24 after reconstruction.Conclusion. Reconstruction using prelaminated bioengineered flaps allows recreating the anatomical integrity and function of the hypopharynx.

Salivary bypass tube in total laryngectomy: Systematic review and meta-analysis.

The aim of this study is to determine whether the preventive positioning of a salivary bypass tube (SBT) after total laryngectomy (TL) reduces the incidence of postoperative pharyngocutaneous fistula (PCF) and pharyngeal stenosis (PS). This study was conducted in conformity with the PRISMA statement. 1960 patients with a median age of 62.0 years were included. A SBT was placed in 980 (50%) patients (SBT group). The cumulative PCF incidence in the SBT group was 15.8% (95% CI: 9.3-23.6). The measured pooled OR comparing PCF incidence in patients with SBT compared to those without was 0.40 (95% CI: 0.24-0.65). The pooled PS incidence in the SBT group was 12.3% (95% CI: 5.4-21.6). The measured pooled OR comparing PS incidence in patients with SBT compared to those without was 0.43 (95% CI: 0.24-0.65). PCF and PS could be prevented by the intra-operative placement of a SBT.

Awake tracheal intubation with C-MAC® video laryngoscope in a patient with corrosive injury-induced pharyngeal stricture.

Awake tracheal intubation with C-MAC® video laryngoscope in a patient with corrosive injury-induced pharyngeal stricture.

Pharyngeal reconstruction for severe pharyngeal stenosis in Behçet's disease: a retrospective case series.

Pharyngeal scarring stenosis is a rare yet very severe complication in Behçet's disease (BD). Previously, such patients had to undergo tracheostomy for life, which seriously affected the patient's speech and swallowing function. We aim to present the effect of pharyngeal reconstructive surgeries using flaps for severe pharyngeal stenosis in BD. The medical history, the surgical procedures of reconstruction and the clinical outcomes of BD cases with pharyngeal stenosis were analysed. British Medical Research Council questionnaire (MRC), Chinese version of the Swallowing Quality-of-Life Questionnaire (SWQOL), the dysphagia score (DS) and the penetration-aspiration scale (PAS) based on videofluoroscopic swallowing study were used. Six BD cases with pharyngeal stenosis underwent reconstructive operations. Submental island flaps and forearm free flaps were used in reconstructive procedures in three female and three male patients, respectively. All patients successfully removed the tracheotomy cannula and nasal feeding tube after reconstruction. Dyspnoea was significantly relived as MRC scores decreased from 3 (3-4) to 1 (1-2) (p=0.020, Z=-2.333). SWQOL scores were remarkably improved from 782.5 (657.0-854.0) to 826.5 (768.0-864.0) (p=0.027, Z=-2.207). There was non-significant decrease in DS (from 2.5 to 1.5, p=0.066, Z=-1.841) and increase in PAS (from 1 to 1.5, p=0.317, Z=-1.000). Reconstructive surgery using flaps is an effective and safe approach to rebuild pharyngeal cavity in BD patients with severe pharyngeal stenosis, which can improve the quality of life of these patients.

Difficult airway following inhalational burn injury in a child

Airway management in a burn victim poses special challenges for the anaesthesiologist not only during the acute phase but also after delayed consequences have set in resulting in difficulty in airway management. We report a 5-year-old boy who was admitted to the Department of Paediatrics with biphasic stridor 2 months following inhalational burn injury. He presented with complaints of difficulty in swallowing solid food, hoarseness of voice for the past 1 month and occasional difficulty in breathing for the past 10 days. Laryngoscopy using a #2 Macintosh blade revealed pharyngeal stenosis with grossly distorted airway anatomy. The patient was finally intubated after great difficulty with a 3.5 mm internal diameter endotracheal tube using a fibrescope.

Outcome of Total Laryngectomy in Regional Hospitals of Bangladesh

Objectives: To analyze post operative complications, local recurrence, functional outcome of speech & swallowing and survival rate following total laryngectomy. Methods: This prospective observational study was done in four major tertiary care medical college hospitals of Bangladesh from July 2000 to December 2019. All operations were done by a single surgeon, one of the authors of this study based on the personal experience. 45 patients were selected who underwent total laryngectomy for biopsy proven advanced (T3 and T4) laryngeal cancer as primary case & recurrent cases following radiotherapy. Patients were followed up monthly for three months and then six monthly for two years and yearly for rest of their life. Results: Age of the patients ranged from 42 to 80 years with mean age 56.7 years. In postoperative period 03 (6.6%) patients developed wound infection, 03 (6.6%) stomal stenosis, 03 (6.6%) stomal recurrence, 02 (4.4%) seroma, 02 (4.4%) pharyngo-cutaneous fistula and 01 (2.2%) case developed pharyngeal stenosis. In post laryngectomy voice rehabilitation 33 (73.3%) cases used esophageal voice, 07 (15.5%) cases used electrolarynx and 05 (11.1%) cases used bloom singer valve. Out of oesophageal speech, 2 patients had poor speech, Regarding swallowing all patients had very good swallowing except one patient who got pharyngeal stenosis, needed dilation. 3 patients died in subsequent 2 years follow-up and overall survival was 93.3%. Conclusion: Outcome of total laryngectomy depends on site and size of tumour, nodal metastases, recurrent cases and co-existing co-morbidities. Total laryngectomy with or without radiotherapy offers significantly higher local control and survival benefit with advanced laryngeal cancer, compared to radiotherapy only. Bangladesh J Otorhinolaryngol 2021; 27(2): 139-144

"Penetrating Neck Injuries: A Comprehensive Study".

Penetrating neck injuries are defined as injury to the neck associated with breach in the platysmal muscle layer. All penetrating neck injuries are potentially dangerous and require emergency intervention due to its proximity to airway, important blood vessels, nerves and other organs in the neck. A complete evaluation, rapid airway intervention and proper surgical repair are highly essential to prevent complications. Clinical evaluation and management of penetrating neck injuries at a tertiary care hospital. In this study, 66 cases of penetrating neck injuries who presented to the emergency department from October 2018 to September 2020 were included. The particulars of the insult like type of instrument causing injury and zone of injury were compared. An analysis of the management of penetrating neck injury with respect to exploration and wound repair and the need for tracheostomy, vascular repair, esophageal repair, laryngeal framework repair and pharyngeal repair was made. The maximum incidence was observed for the age group between 21 and 30years. The object causing the maximum number of neck injuries was knife, in 36 cases. The distribution of cases according to zone of injury revealed that the zone II was most commonly affected in 43 cases. The structures injured in the study indicated that platysma was involved in all the cases, followed by thyroid cartilage in 33 cases. Wound exploration and repair was done in all cases and tracheostomy was done in 44 cases. Complications were vocal cord palsy in 19 patients, 15 had tracheal stenosis, 13 had hoarseness of voice, 7 developed pharyngocutaneous fistula and 1 developed pharyngeal stenosis. There were 2 deaths. 16 patients who attempted suicide had depression. All penetrating neck injuries are potentially dangerous and require emergency treatment because of the presence of important vessels, nerves andorgans in the neck. Thorough knowledge of the anatomy of neck, clinical assessment and diagnostic and therapeutic interventions are necessary for appropriate management.

Right colonic interposition for severe pharyngoesophageal stricture in head and neck patients: A feasible rescue strategy after multiple failed reconstructive options

Severe pharyngeal stricture is an uncommon complication that may occur afer laryngectomy especially in irradiated patients. Its management is a challenge and high risk of recurrence after reconstruction exists.We present two patients with severe end-stage pharyngoesophageal stricture after several failed attempts of reconstruction with regional and free flaps, in which a right colon transposition was performed. Twenty days after surgery both patients were able to tolerate an oral diet, and no minor or major complications were observed. Right colonic transposition may be a valid option for secondary pharyngeal reconstruction if other less invasive methods such as regional or free flaps have failed to restore the pharyngoesophageal continuity or if the inferior location of stricture makes a tension free anastomosis impossible.

Radiation-induced dysphagia and life-threatening stridor in nasopharyngeal carcinoma

Radiotherapy plays an important role in the treatment for head and neck cancer. The radiation to the head and neck region can lead to a rare long-term swallowing and breathing defect by causing stenosis at the pharynx which reduces the quality of life. We are presenting a case of radiation-induced severe pharyngeal stenosis in a 44-year-old female diagnosed with nasopharyngeal carcinoma. Nasopharyngeal carcinoma is a rare variety of the cancer where radiation therapy is the treatment of choice because of its high radiosensitivity. Radiation-induced dysphagia may occur due to structural, mechanical, and neurological deficits. Although radiotherapy has a promising outcome in nasopharyngeal carcinoma, complications around the irradiation areas are inevitable and lead to compromised quality of life. Although there is no effective treatment option available for pharyngeal stenosis, many supportive, restorative, and palliative treatments are available under different clinical situations. Here, we report a case of postradiation-induced pharyngeal stenosis presenting with dysphagia and stridor that underwent treatment with pharyngeal dilation with coblation.

Technique of neo-pharynx reconstruction with supra-clavicular artery island flap in a case of pharyngeal stricture

<p class="abstract">Pharyngeal stenosis frequently occurs after laryngectomy or laryngo-pharyngectomy, more commonly in patients complicated with a post-operative pharyngo-cutaneous fistula. Oral feeding becomes challenging, restricted to liquids. In such cases, dilatations can be futile if there is a complete stricture necessiating surgery. We present a case of 72 -year-old man who underwent total laryngectomy with partial pharyngectomy with pectoral major myocutaneous flap reconstruction for second primary of hypopharyngeal T3N0M0, after primary laryngeal T1N0M0 treated with RT presented with nearly 4 cm pharyngeal stricture causing him absolute dysphagia. Multiple dilations failed to create adequate passage, pharyngeal stricture was then excised, and a neopharynx was constructed with supraclavicular artery island flap. The outcome was uneventful with restoration of normal pharyngeal permeability and swallowing by 12<sup>th</sup> post-operative day. Post-operative follow-up after 8 months remained satisfactory. Resection of limited height pharyngeal stenosis can be successfully performed as end-to-end anastomosis whereas reconstruction of a long segment pharyngeal stricture utilizing a loco-regional flap gives satisfactory outcome.</p>

A New Classification System to Predict Functional Outcome after Laryngectomy and Laryngopharyngectomy.

Simple SummaryEvaluation of the long-term functional outcome after primary or salvage laryngopharyngectomy. Long term functional outcome mainly depends on extent of pharyngectomy and salvage situation, which is reflected by our new classification system. (1) Objective: To evaluate long-term functional outcome in patients who underwent primary or salvage total laryngectomy (TL), TL with partial (TLPP), or total pharyngectomy (TLTP), and to establish a new scoring system to predict complication rate and long-term functional outcome; (2) Material and Methods: Between 1993 and 2019, 258 patients underwent TL (n = 85), TLPP (n = 101), or TLTP (n = 72). Based on the extent of tumor resection, all patients were stratified to (i) localization I: TL; II: TLPP; III: TLTP and (ii) surgical treatment (A: primary resection; B: salvage surgery). Type and rate of complication and functional outcome, including oral nutrition, G-tube dependence, pharyngeal stenosis, and voice rehabilitation were evaluated in 163 patients with a follow-up ≥ 12 months and absence of recurrent disease; (3) Results: We found 61 IA, 24 IB, 63 IIA, 38 IIB, 37 IIIA, and 35 IIIA patients. Complications and subsequently revision surgeries occurred most frequently in IIIB cases but rarely in IA patients (57.1% vs. 18%; p = 0.001 and 51.4% vs. 14.8%; p = 0.002), respectively. Pharyngocutaneous fistula (PCF) was the most common complication (33%), although it did not significantly differ among cohorts (p = 0.345). Pharyngeal stenosis was found in 27% of cases, with the highest incidence in IIIA (45.5%) and IIIB (72.7%) patients (p < 0.001). Most (91.1%) IA patients achieved complete oral nutrition compared to only 41.7% in class IIIB patients (p < 0.001). Absence of PCF (odds ratio (OR) 3.29; p = 0.003), presence of complications (OR 3.47; p = 0.004), and no need for pharyngeal reconstruction (OR 4.44; p = 0.042) represented independent favorable factors for oral nutrition. Verbal communication was achieved in 69.3% of patients and was accomplished by the insertion of voice prosthesis in 37.4%. Acquisition of esophageal speech was reached in 31.9% of cases. Based on these data, we stratified patients regarding the extent of surgery and previous treatment into subgroups reflecting risk profiles and expectable functional outcome; (4) Conclusions: The extent of resection accompanied by the need for reconstruction and salvage surgery both carry a higher risk of complications and subsequently worse functional outcome. Both factors are reflected in our classification system that can be helpful to better predict patients’ functional outcome.

GERD and adjuvant radio-chemotherapy predespose to recurrent voice prosthesis leakage

We performed a retrospective analysis of 58 Patients after laryngectomy. Additionally, we analyzed pre- and post-therapeutic CT-scans of 22 Patients regarding pharyngeal stenosis. In 40 Patients, at least one replacement of voice prosthesis was documented during observation period, median device life was 235 days. Patients treated with adjuvant radiotherapy (RT) showed a significantly longer device life than patients with adjuvant radio-chemotherapy (RCT, p = 0.002). Furthermore, patients suffering of gastroesophageal reflux disease (GERD) showed a significantly shortened device life (p = 0.04).17 patients (42.5 %) suffered of clinically relevant stenosis of the neopharynx, which was treated with dilatation in 14 patients (82 %) and did not affect prosthesis device life. GERD is a risk factor for shortened voice prosthesis' device life and therefore should be treated effectively after laryngectomy. Also, adjuvant RCT predisposes a shortened device life.Stenosis is observed frequently after laryngectomy but does not affect device life when effectively treated.

Congenital Pharyngeal Web in an Adult: Treatment of a Rare Clinical Anomaly by Coblation

INTRODUCTION TO THE TOPICPrevious reports of congenital pharyngeal webs, although rare, have been described in children. Clinical presentation varies, ranging from aspiration to intermittent airway obstruction, and most commonly, dysphagia. In this case report, the authors describe an unusual finding of a hypopharyngeal web in an adult patient. This patient had no prior history of chemoradiotherapy, malignancy, or total laryngectomy, all of which have been associated with acquired pharyngeal stenosis, supporting that this finding was of congenital origin. After a review of the possible embryological developmental abnormalities, the hypothesis is that of gut recanalization failure during development.CASE PRESENTATIONWe present a case of a woman in her mid-40’s with a history of solid food dysphagia resulting in a 20 kg weight loss over three months. The patient denied dysphagia progressing to liquids, pain with swallowing, and a history of alcohol or tobacco use. Upon examination of the larynx via laryngoscope, a congenital hypopharyngeal web was identified. Successful excision of the web via coblation restored proper drainage of the pyriform sinus into the esophagus and resulted in markedly improved swallowing function and weight gain.CONCLUSIONSPharyngeal webs are rare findings, particularly in adult patients. These congenital anomalies can be safely and effectively treated endoscopically via coblation.

Functional Endoscopic Evaluation of Swallowing in Patients Treated by Total Laryngectomy and Adjuvant Treatment for Advanced Laryngeal and Hypopharyngeal Malignancies.

Treatment of locally advanced laryngeal and hypopharyngeal cancers often requires total laryngectomy with partial pharyngectomy and adjuvant radiotherapy. Dysphagia is common after such aggressive treatment which is often under reported, but adversely affects the quality of life in these patients. The cause for this dysphagia is loss of pharyngeal mucosa, fibrosis, disruption of constrictors and loss of skeletal support to soft tissues. In this study 32 patients treated by laryngectomy with partial pharyngectomy and adjuvant radiotherapy underwent fibreoptic endoscopic evaluation of swallowing at 6 and 12weeks after completion of treatment. Majority of them had delayed transit of bolus, dryness and edema and 6 of them had pharyngeal stenosis, 2 had fibrotic band and 2 had adynamic pharyngeal segments. These findings were the cause of dysphagia. The frequency of occurrence of the above findings and their association with extent of resection of pharyngeal mucosa and adjuvant treatment have been documented. Bilateral neck dissection, post operative chemotherapy with radiotherapy and use of myocutaneous flap for the reconstruction of neopharynx were found to cause severe dysphagia in our series. Some of these patients benefitted by swallowing therapy, diet modifications and nasogastric feeding. Therefore early identification of cause of dysphagia in these patients and timely intervention to facilitate rehabilitation can improve the quality of life and reduce the long term morbidity in these patients.

Scar contracture prevention with local steroid injections in transoral videolaryngoscopic surgery

ObjectiveThe aim of this study was to evaluate the efficacy and safety of local steroid injections to prevent scar contracture after transoral videolaryngoscopic surgery (TOVS) in hypopharyngeal cancer patients. MethodsPatients were enrolled in this study if they had received a local steroid injection during TOVS and had attended an outpatient clinic after at least three months. All patients were being treated for hypopharyngeal cancer and received a single session of triamcinolone acetonide, injected using a 21-gage needle. Retrospective chart reviews were performed, and the degree of scar contracture, pharyngeal stenosis, vocal fold movements, and adverse events were evaluated. Scar contracture was assessed using a scoring system, which compared the endoscopic findings of treatment and matched pair control groups. ResultsA total of 20 patients received local steroid injections during TOVS and were enrolled in the treatment. Scar contracture was seen in 14 patients (70%); however, the degree of scar contracture was significantly decreased when compared to control cases. Vocal fold immobility was observed in five patients, but no pharyngeal stenosis was noted. Adverse effects, such as postoperative laryngeal chondritis or cervical spondylitis, were seen in three patients who had previously been treated with resection to the muscularis propria or definitive irradiation. ConclusionLocal steroid injection during TOVS significantly reduced the degree of postoperative scar contracture. However, caution should be used when treating with local steroid injection during TOVS, as this may complicate wound healing in patients who have already received treatment.

Complications of Total Laryngectomy

Objective: To observe Post-operative complications of Total Laryngectomy in advanced Laryngeal Carcinoma Patients.&#x0D; Methods: This prospective observational study was conducted in National Institute of ENT, Tejgaon, Dhaka. Study duration 3 years, from January 2015 to December 2017. 17 patients were selected who underwent total laryngectomy for histologically proven advanced carcinoma larynx. Patients were followed up monthly for 3 months &amp; then after 6 months for life long.&#x0D; Results: The age of the patients ranged from 39 to 66 years. The mean age was 47 years. Most of the cases are supraglottic carcinoma 12 (70.59%), Glottic carcinoma in 5 (29.41%) &amp; no subglottic carcinoma. In this study, out of 12 supraglottic cases, 4 patients were presented in stage III &amp; 8 in stage IV. Among the glottic cases 1 patient presented in stage I, 2 in stage III &amp; 2 patients presented in stage IV. Patients were followed up monthly for 3 months &amp; then after 6 months for life long. 2 patients (11.76%) developed pharyngocutaneous fistula within 7th to 15th post-operative day &amp; these patients were managed conservatively which involved adequate drainage, frequent dressing &amp; fresh blood transfusion. With these conservative management fistula healed completely within 3 to 4 weeks. 3 patients (17.65%) developed wound infection. Wound swab was sent for culture &amp; sensitivity and antibiotics changed accordingly. Wound healed within 2-3 weeks with conservative treatment &amp; adequate aseptic dressing. 1 patient (5.88%) developed postoperative hematoma which was drained immediately. This patient developed wound infection later on &amp; was managed conservatively. 2 patients (11.76%) developed stomal recurrence 4 months after surgery, which was confirmed by biopsy. The cases were inoperable &amp; were sent for radiotherapy. 2 patients (11.76%) developed dysphagia due to pharyngeal stenosis 4 months after surgery.&#x0D; Conclusion: The most frequent troublesome immediate complication is pharyngocutaneous fistula all of which have been treated conservatively with satisfactory result. Preoperative radiotherapy is an important risk factor for the development of pharyngocutaneous fistula in total laryngectomy.&#x0D; Bangladesh J Otorhinolaryngol; April 2019; 25(1): 10-18

Pharyngeal stricture treated by endoscopic adhesiolysis.

Pharyngeal stricture treated by endoscopic adhesiolysis.

Dilation after laryngectomy: Incidence, risk factors and complications

BackgroundNeopharyngeal stenosis is a recognized sequela of total laryngectomy (TL). We aim to investigate the incidence of stenosis requiring dilation, risk factors for stenosis and complications of dilation. MethodsRetrospective cohort study of patients undergoing TL in two dedicated head and neck centers in the Netherlands. ResultsA total of 477 patients, (81% men, median age of 64 at TL) were included. Indication for TL was previously untreated primary tumor in 41%, salvage following (chemo)radiotherapy (CRT) in 44%, dysfunctional larynx in 9% and a second primary tumor in 6%. The cumulative incidence of dilatation at 5 years was 22.8%, and in total 968 dilatations were performed. Median number of dilations per patient was 3 (range 1–113). Female gender, a hypopharynx tumor, and (C)RT before or after the TL were significantly associated with stenosis requiring dilation. We observed 8 major complications (0.8%) predominantly during the first dilation procedures. Use of general anesthesia is a risk factor for complications. The most frequent major complication was severe esophageal perforation (n = 6 in 5 patients). ConclusionThe cumulative incidence of pharyngeal stenosis needing dilation was 22.8% at 5 years. Roughly half of these patients could be treated with a limited number of dilations, the rest however needed ongoing dilations. Major complications are rare (0.8%) but can be life threatening. General anesthetics is a risk factor for complications, and complications occurred predominantly during the first few dilations procedures. This should alert the physician to be extra careful in new patients.