The longus colli muscle flap for reconstruction of the lateral pharyngeal wall

Full-thickness lateral pharyngeal wall (LPW) defects are difficult to reconstruct, whether the larynx is preserved or removed (extended total laryngectomy). A simple, reliable reconstructive method using local tissue which optimizes wound healing and functional results would allow partial laryngectomy more often, without incurring the cost, donor site morbidity, and increased operative length of regional or free flaps. My objective was to propose use of the longus colli muscle as a reconstructive flap for defects of the LPW.

Results of using the longus colli muscle flap (LCMF) in a series of 16 patients with primary tumors of the pharyngeal wall or pyriform sinus are presented. The majority had surgery and planned postoperative radiotherapy.

There were no wound infections or fistulas. One of 2 previously radiated patients had a transient wound-healing problem. Although 88% of the patients were stage III and IV and 50% had T3-4 primary tumors, there were only 2 local failures, for a local control rate of 88%. Corresponding cancer-free survival was 69% (median follow-up of 22 months). Two thirds of the patients took all or some food by mouth, and of the 12 with larynx preserved, 58% were decannulated, and 11 had a good to normal voice.

The reliability of wound healing and absence of negative impact on oncologic and functional results validate use of the LCMF as a reconstructive option for defects in the LPW at both the oropharynx and hypopharynx levels.