A CASE OF HYPOPHARYNGEAL STENOSIS CAUSED BY LATE RADIATION INJURIES

RECONSTRUCTION OF THE HYPOPHARYNX WITH MYOMUCOSAL TONGUE FLAP

Abstract

The authors reported a 47-year-old man with hypopharyngeal stenosis caused by late radiation injuries. At the age of ten he underwent irradiation (3000rads) to the neck because of the cervical lymphadenopathy. He had keroid skin change at the age of 19, hypothyroidism since 26, right cervical and brachial plexus neuropathy since 33, and paralysis and papilloma of right vocal cord at 34. And at the age of 41 he underwent tracheostomy owing to laryngeal stenosis.
In November 1984 (at age 43) he felt abnormal sensation on the throat but had no dysphagia nor misdigulutition. On November 1987 he had difficulties of swallowing, and could not take anything but fluid. At that time he was diagnosed as hypopharyngeal stenosis. With steroids and antibiotics his difficulties of swallowing were reduced. He experienced the same difficulties on April 1988. Since December 1988 his dysphagia got worse and was not recovered with medication.
On May 17 1989, laryngopharyngectomy was performed. At the level of cricoid cartilage iypopharynx was resected. As for the posterior wall, pharynx and cervical esophagus were fixed :o prevertebral fascia and anastmosed with end-to-end. And antero-lateral defects were recon-;tructed with myomucosal tongue flap. Postoperatively he could eat orally.
On the basis of the experience of this case and the review of the literature the authors conclude hat myomucosal tongue flap is one of alternatives for hypopharyngeal reconstruction.