Swallowing function after partial hypopharyngectomy with free-flap reconstruction

We analyzed a total of 34 cases who had undergone partial hypopharyngectomy with laryngeal preservation followed by free-flap reconstruction surgery in terms of swallowing function and its influencing factors such as the patient’s age, the range of partial resection, the kind of flap tissue, and the postoperative structural changes of the larynx and its surroundings. There was no statistically significant relationship between the patient’s age and the frequency of aspiration pneumonia, but some cases in the long-term follow-up showed increased susceptibility to aspiration pneumonia with age. Although not statistically significant, 45% of the patients whose resection ranges were so large as to include the arytenoid cartilage suffered aspiration pneumonia. Jejunal patch graft exceeded other skin flaps in number with 22 cases. There was no relationship between the kinds of tissue for free flap and the tendency toward aspiration pneumonia. The frequency of aspiration pneumonia when reconstruction of the aryepiglottic fold was conducted with a jejunal patch graft was no different than when conducted with skin flaps. As to the morphological changes of the surroundings of the larynx after reconstruction surgery, it was confirmed that a mucosal ridge between the aryepiglottic fold and the pyriform sinus was effective for preventing laryngeal penetration. Also, it seemed important to secure a broad space between the base of the epiglottis and the wall of the pharynx.