Partial Laryngopharyngectomy Followed by Secondary Reconstruction for Carcinoma of the Piriform Sinus

Abstract

In selected cases of piriform sinus carcinoma, total laryngectomy is not necessarilyrequired to eradicate the disease. Partial laryngectomy consisting of ipsilateral removalof the supraglottis frequently suffices to eradicate the carcinoma. Total laryngectomy has been performed in such cases because severe aspiration occurs after partialremoval. This paper describes a technique of partial laryngopharyngectomy followed by secondary reconstruction. In the first step, we remove the piriform sinus, one thirdto one half of the epiglottis, the aryepiglottic fold, the arytenoid region, the false fold, most or all of the arytenoid cartilage, half of the hyoid bone, and approximately one thirdof the thyroid cartilage ipsilaterally. The larynx and pharynx are kept open by suturingthe mucosa to the cervical skin. The second step, or reconstructive surgery, employstwo hinge flaps and a DP flap. One of the hinge flaps is used to line the larynx, andthe other lines the hypopharynx. In part, the two flaps are sutured back to reconstruct the aryepiglottic fold, i. e. to form a wall between the larynx and the pharynx. The cervical wound is then covered by the DP flap.