Functional restoration after subtotal glossectomy and laryngectomy

Area of Science:

• Head and Neck Surgery
• Surgical Oncology
• Reconstructive Surgery

Background:

• Extensive resection for tongue base and supraglottic larynx cancer often leads to significant morbidity, mortality, and functional deficits like aspiration.
• Radiotherapy alone provides limited palliation, and traditional reconstruction methods yield unsatisfactory deglutition outcomes.
• Simultaneous or delayed total laryngectomy is frequently required to manage pulmonary complications, further impacting function.

Purpose of the Study:

• To evaluate a combined surgical approach for advanced squamous cell carcinoma involving the tongue base and supraglottic larynx.
• To assess the efficacy of pectoralis myocutaneous flap reconstruction and tracheopharyngeal shunt creation for functional rehabilitation.

Main Methods:

• Eight patients with advanced squamous cell carcinoma of the tongue base, vallecula, and supraglottic larynx underwent partial or subtotal glossectomy and laryngectomy.
• The mucosal defect was reconstructed using a pectoralis myocutaneous flap.
• A primary tracheopharyngeal shunt was created using portions of the cricoid and upper trachea to restore voice.

Main Results:

• The pectoralis myocutaneous flap successfully reconstructed the oropharyngeal defect.
• The tracheopharyngeal shunt facilitated voice restoration.
• The majority of patients achieved successful rehabilitation of deglutition, mastication, and speech.

Conclusions:

• Combined glossectomy, laryngectomy, pectoralis myocutaneous flap reconstruction, and tracheopharyngeal shunt creation is an effective strategy for managing advanced head and neck cancers.
• This approach offers significant functional recovery, improving swallowing, chewing, and speech in patients with extensive tumors.