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Pharyngoesophageal Reconstruction

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Advancements and Innovations in OMFS, ENT, and Facial Plastic Surgery

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Abstract

With the advent of effective organ preservation treatment strategies for malignancies of the larynx and hypopharynx, total laryngectomy and pharyngectomy procedures are now performed primarily for patients with locally advanced disease or in the salvage setting. Pharyngoesophageal reconstruction represents a complex challenge as the reconstructive surgeon must balance numerous considerations, including facilitating speech and swallow rehabilitation, reducing risk of pharyngocutaneous fistula, minimizing donor site morbidity, and preventing delays in adjuvant therapy. Techniques to introduce healthy, vascularized tissue to radiated fields such as regional pedicled flaps and now microvascular free tissue transfer (MVFTT) and enteric flaps have significantly reduced the rates of complications seen in early organ preservation trials such as RTOG 91-11. In recent years, MVFTT has increasingly been utilized in the salvage setting given superior functional outcomes and complication rates. Thorough understanding of the anatomy and physiology of the pharynx, careful consideration of each patient’s clinical history and comorbidities, and knowledge of the full gamut of available reconstructive options are critical in the management of these challenging defects.

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Authors and Affiliations

  1. Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA

    Ray Y. Wang, Caitlin M. Coviello & Andrew T. Huang

  2. Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Mohammad S. Jafferji & Shawn Groth

Authors
  1. Ray Y. Wang
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  2. Caitlin M. Coviello
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  3. Mohammad S. Jafferji
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  4. Shawn Groth
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  5. Andrew T. Huang
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Correspondence to Andrew T. Huang .

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Editors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA

    James C. Melville

  2. School of Medicine, New York University, New York, NY, USA

    Paulo G. Coelho

  3. Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Simon Young

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Wang, R.Y., Coviello, C.M., Jafferji, M.S., Groth, S., Huang, A.T. (2023). Pharyngoesophageal Reconstruction. In: Melville, J.C., Coelho, P.G., Young, S. (eds) Advancements and Innovations in OMFS, ENT, and Facial Plastic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-32099-6_8

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