Pharyngectomy & Reconstruction
Pharyngectomy is a type of surgery that can be done for the removal of all or part of the pharynx.
Some facts about Pharynx and Pharyngectomy:
- Pharynx is the hollow tube inside the neck which is the part of the throat that lies behind the mouth and nasal cavity and above the esophagus and the larynx.
- The mouth and nose is connected to the esophagus through Pharynx.
- A pharyngectomy could be a small surgery that involves removal of a tiny tumor on the back wall of the oropharynx or could be a major resection requiring a free flap reconstruction.
- Pharyngectomy is done as part of the removal of another tumor that extends into the pharynx in many cases.
- A pharyngectomy may also be done to treat certain types of throat cancer.
- Patients with throat cancer including cancer of the nasopharynx, oropharynx or hypopharynx and patients with hypopharyngeal carcinoma are suitable candidate for a pharyngectomy.
- Surgery may be the only option for patients whose cancer came back or was not completely eliminated after chemotherapy or radiation
- Chemotherapy and/or radiation in addition to surgery may be required in many cases.
- The need for a total or partial pharyngectomy will be decided based on the stage and location of your throat cancer.
- A laryngectomy may also be required to remove your larynx in the same procedure as the pharyngectomy.
- Partial pharyngectomy can be done for patients with well-contained early stage throat cancer.
- A laryngopharyngectomy is more appropriate for more advanced cancers and need the surgical removal of the entire larynx, part of the esophagectomy as well as the pharynx.
Procedure for Pharyngectomy & Reconstruction:
- Total Laryngectomy with Partial Pharyngectomy is the procedure of removing the larynx, along with part of the pharynx immediately next to it
- The patient may require a flap to reconstruct the pharynx if a significant portion of the pharynx is removed.
- The radial forearm free flap and the pectoralis major flap are the most common types of flaps used to reconstruct the pharynx.
- The entire voice box and the pharynx will be removed in a total laryngopharyngectomy. Hypopharynx, and part of the oropharynx may need to be removed depending on the extent of the tumor in this procedure.
- The trachea will be sewn to the skin above your breast bone after the removal of the voice box and pharynx. A permanent breathing hole (stoma) in that area will be created.
- The tube connecting your mouth to your esophagus will be recreated by a reconstructive procedure to eat again
- Reconstruction of the pharynx can be done in many ways.
- Radial forearm free flap and the anterolateral thigh free flap are the most commonly used free flaps for this purpose, in which the skin is turned into a tube to recreate the pharynx.
- A pectoralis major muscle/skin flap might be used in some cases.
- A plastic salivary bypass tube may be placed into the reconstructed area created by your surgeon to aid healing which is temporary.
- Neck dissections, removal of at least one lobe of the thyroid gland, and/or feeding tube placement are some additional procedures performed during a laryngopharyngectomy.
- Initially, your food and drink will be given through your feeding tube which is inserted either through the nose or directly in the stomach or through the tracheoesophageal puncture (TEP) to allow the reconstruction to heal.
- A few small drains (JP drains) will be placed to drain any blood and/or fluid coming out of your skin which might accumulate in the space created by removing the larynx and pharynx as well as from the fat and lymph nodes from the neck dissections
- The drains will be removed by your surgical team after a few days of surgery.
