[Functional and cancerologic aspects in the use of jejunum in the ENT area]

[Total laryngopharyngectomy and reconstruction with a jejunum speech siphon : A case report]

Advanced laryngeal and hypopharyngeal carcinomas are associated with a poor prognosis and a pronounced loss of quality of life due to impairment of the swallowing and voice function. The fundamental therapeutic challenge is successful tumor control with concomitant rehabilitation of swallowing and voice functions. Further objectives are a low complications rate (fistula, aspiration) and prompt transfer to the adjuvant radio-oncologic therapy. With these factors in mind, the microvascular anastomosed jejunum speech siphon with a biventer rein has proven to be an effective method of reconstruction following extensive circular laryngopharyngeal resections. In this case report, a typical operative and postoperative course is presented, as are the functional results.

Contrast-enhanced computed tomography of freely transplanted jejunal patches after surgery in the oral cavity and oropharynx

Thirty-two patients with jejunal patches in the oral cavity and oropharynx were examined with contrast-enhanced computed tomography (CT). The morphology of the intestinal wall, the mesenteric fatty tissue, mesenteric lymph nodes and the region of the anastomosis were evaluated and correlated with clinical findings. The size and number of mesenterial lymph nodes, which were found in 16 cases, did not correlate with tumour recurrence. The benign alterations of the intestinal wall ranged from flat surfaces with no enhancement to significant enhancement with persisting folds. In cases with persisting intestinal folds, separation of tumour recurrence was achieved by identification of a typical double-layer configuration of the enhancing mucosa, and the restriction of alterations to the intestinal wall compartment. Tumour recurrences occurred at patch margins and were reliably distinguished from normal patches. For differentiation of findings, an exact localization of jejunum-patch compartments and margins with contrast-enhanced CT was, therefore, necessary.

Dysphagia after pharyngolaryngeal cancer surgery. Part II: Implications for reconstructive procedures

In the base of the tongue region, reconstructive procedures have to provide more bulky-tissue coverage (i.e., myocutaneous flaps) in order to avoid cranial release of pressure and to bring about swallowing initiation. Resections of the pharyngoesophageal (PE) segment cause circular defects, always affecting the sphincter and necessarily relaxation, thus reducing the hypopharyngeal suction pump. The resistance to bolus flow, therefore, is generally increased but can be compensated by a stronger tongue driving force. In addition to the functional obstruction, special attention is called to the growing lumen discontinuity between the wide pharynx and the narrow esophagus. Plastic reconstructions, therefore, have to compensate for different lumina distally. Following ablative surgery in the upper esophageal sphincter region, a softer and smoother tissue coverage is warranted in order to facilitate bolus transfer to a passive bolus flow if necessary. For that purpose, a new myofascial pectoralis flap was designed based on morphometric investigations and postmortal selective injection studies. In this flap, the bulky muscle mass is separated from just a vascularized, thin fascia-muscle layer. The donor site is covered with the remaining bulky muscle-skin complex left intact. The fascial flap covers defects where a soft lining is required and replaces the PE segment as a tubed neopharynx. Histologic specimens show a reepithelization with local mucous membrane from the anastomotic site to the fascial surface. The resistance to bolus flow is reduced, thus alleviating the tongue driving force, which is increased for compensation in any case.