A SIMPLE PROCEDURE FOR RECONSTRUCTION OF HYPOPHARYNX WITH A FREE JEJUNAL GRAFT

Abstract

Although an antimesenteric incision can be used to conform the diameter of the oral end of a jejunal graft to that of a pharyngeal defect, technical problems and swallowing problems may arise after end-to-side pharyngojejunal anastomosis. The high vascularity of jejunal grafts after longitudinal paramnesenteric incisions was investigated, and a simple operative procedure for correcting large pharyngeal defects with free jejunal grafts was developed.
The shape of the pharyngeal defects was classified as oblique or horizontal. For reconstruction of oblique defects, a longitudinal incision is made at the corner of the side opposite the highest point of the defect. Defects of the hypopharynx can be reconstructed with end-to-eod anastomosis of a free jejunal graft regardless of the location of the most extensive point of the defect or of the recipient vessels. For reconstruction of horizontal defects, a longitudinal incision is made at the anterior part of the transferred jejunum.
Incisions 2 to 8cm long have successfully been used to transfer 54 free jejunal grafts whose diameters were less than those of the pharyngeal defects. Oblique defects (26 cases) included extensive defects that reached the level of torus of the auditory tube, and horizontal defects (28 cases) included extremely wide defects after total glossectomy with laryngectomy. Transfer was successful with end-to-end pharyngojejunal anastomosis in all patients, despite minor postoperative leakage in 5 patients (9.2%).
This method allows defects of the lower pharyngeal space to be reconstructed with end-to-end anastomosis of free jejunal grafts regardless of the location of the defect or of the recipient vessels. This method is simpler and more effective than other methods and has few postoperative complications.