Laryngectomy

Laryngeal carcinoma is often treated with surgical resection rather than radiotherapy. During laryngectomies, both partial and complete, the airway is completely separated from the pharyngeal-esophageal conduit. A tracheostomy assures proper respiratory function. The anterior wall of the pharyngoesophagus continuum (neopharynx) is closed, and drains are placed in the soft tissues of the neck [6].

In the immediate postoperative period, leaks (from the pharyngeal closure) and/or pharyngocutaneous fistulas are frequently encountered. Two predisposing factors for the development of fistulas are vomiting during the postoperative period [7] and gastroesophageal reflux [8]. The performance of a laryngectomy itself might actually cause to an increased incidence of gastroesophageal reflux [9]. Many of these fistulas can be observed, the patient's nutrition supported by enteral tube feedings, and surgery avoided [10].

In the late postoperative period, changes can be seen in both the form and function of the pharyngoesophageal region. Narrowing of the superior end of the surgical closure of this region can be seen in half of all patients and pseudodiverticula in almost half [11,12]. The latter represents an outpouching of the neopharyngeal lumen (Fig. 2.1). This outpouching is separated from the rest of the neopharynx by an oblique lucency that has been described as a pseudoepiglottis (Figs. 2.2 and

Figure 2.1. Dilated neopharynx. Lateral film Figure 2.2. Small pseudoepiglottis. Lateral film from a cervical esophagram demonstrating a from a cervical esophagogram demonstrating a markedly dilated hypo- and neopharynx in a small filling defect in the anterior neopharynx, patient following total laryngectomy. the so-called pseudoepiglottis.

Figure 2.1. Dilated neopharynx. Lateral film Figure 2.2. Small pseudoepiglottis. Lateral film from a cervical esophagram demonstrating a from a cervical esophagogram demonstrating a markedly dilated hypo- and neopharynx in a small filling defect in the anterior neopharynx, patient following total laryngectomy. the so-called pseudoepiglottis.

Figure 2.3. Larger pseudoepiglottis. Another, larger example of a pseudoepiglottis in the neopharynx of a postlaryngectomy patient.

Figure 2.4. Pseudodiverticulum of neopharynx.

Lateral film from a cervical esophagogram demonstrating a large posterior bulge at the inferior end of the neopharynx.

Figure 2.4. Pseudodiverticulum of neopharynx.

Lateral film from a cervical esophagogram demonstrating a large posterior bulge at the inferior end of the neopharynx.

2.3). The pseudodiverticulum is actually produced by the surgery itself and does not develop over time. However, it may enlarge secondary to increased intrapharyngeal pressure noted postoperatively, or because of food that becomes trapped in its lumen [12] (Fig. 2.4).

The retropharyngeal (prevertebral) soft tissues increase in thickness, but this does not necessarily indicate tumor recurrence [11] (Fig. 2.5). This finding may be secondary to detachment of the constrictor muscles from the prevertebral tissues. A prominent cricopharyngeus

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