Abstract
We report on a case of closure of a pharyngo-tracheal fistula, which had been performed 30 years ago to restore speech after a total laryngectomy.
The patient had undergone radiation therapy for laryngeal cancer about 30 years ago. A tumor survived after treatment, and a total laryngectomy was performed. At the same time, a pharyngo-tracheal fistula was designed using a forearm free flap, and an original voice prosthesis was emplaced. After the operation, there was no evident pulmonary aspiration and vocalization had improved, and the patient was followed up by a local doctor. However, as the pharyngo-tracheal fistula enlarged with age, the patient began to have difficulty both vocalizing and swallowing. He could take only a liquid diet, and had difficulty caring for the prosthesis by himself.
Initial examination revealed a voice prosthesis at the laryngeal fibers in the pharyngeal cavity. The prosthesis was removed, washed, and replaced by the patient himself. When the vocal prosthesis was removed, the trachea could be observed directly below the pharyngeal cavity. The entrance to the esophagus had been reduced to the size of a pinhole.
Surgery was performed to close the pharyngo-tracheal fistula and reform the esophageal opening. At the upper part of the neck, an inverse U-shaped mark was drawn at the height of the root of the tongue, the pharyngeal cavity was fenestrated, and the esophageal entrance was incised at the valve, and the upper layer of the valve's pharyngeal membrane was denuded and sutured to the anterior pharyngeal mucous membrane. The upper tip of the trachea was closed by the folded skin flap of the neck. The raw surface was covered with the pectoralis major flap for reinforcement. The patient was discharged 2 weeks after surgery without any trouble caused by leakage or infection, and was able to take solid diet.
