[Computerized manometry concept for site-specific reconstruction of the pharynx and pharyngo-esophageal transition]

Fifty-three patients who underwent laryngopharyngeal cancer surgery were examined with a sequential computer manometry system using 4-channel pressure probes. Swallowing coordination is largely independent of the oropharyngeal pressure thrust nor of the pharyngeal transit time and depends mainly on initiation of swallowing. The points of interest are the pharyngeal entrance and outlet. The topographic correlates are the base of the tongue and the upper esophageal sphincter. Resections of the base of the tongue decrease the volume available for pressure generation reducing the driving force of the tongue. Thus, reconstruction at the base of the tongue must provide more bulky-tissue coverage (i.e. myocutaneous flaps) in order to avoid cranial release of pressure and to bring about initiation of swallowing. Resections of the pharyngoesophageal segment cause circular defects that affect the sphincter, reducing hypopharyngeal suction. Thus, the resistance to bolus flow is generally increased, but can be compensated for by an increased driving force of the tongue. Additional pharyngeal and/or lingual resections increase the lumen discontinuity between the wide pharynx and the narrow esophagus, exceeding any compensatory possibilities. Plastic reconstructions therefore have to compensate for different lumina distally. In the region of the upper esophageal sphincter, softer and smoother tissue coverage is warranted in order to facilitate bolus transfer or passive bolus flow if necessary. For that purpose we modified the myofascial pectoralis-major-flap. It covers defects where a soft lining is required. The resistance to bolus flow is reduced, alleviating the need to increase the driving force of the tongue which would otherwise increase to compensate for the defect.