Summary
Radiotherapy is an accepted primary treatment modality for head and neck malignancies.
However, in severe cases, the chronic radiation damage has resulted in dysphagia,
aspiration and choking. Failure in conservative therapeutic strategies for this swallowing
dysfunction will result in either preservation of voice with loss of oral feeding,
or vice versa. We introduce our surgical technique based on the free jejunal diversionary
conduit flaps, which helps patients to resume oral feeding and preserves vocal function,
while reducing the risk of aspiration.
Method
Six patients suffering from swallowing dysfunction following radiotherapy were enrolled.
All were dependent on tube feeding. A subcutaneously transferred free jejunal flap
connected the left buccogingival sulcus to the cervical oesophagus, which permanently
separates the airway from the native aerodigestive tract by creating a new inlet for
food passage. Simultaneously created pharyngostomy drains accumulation of saliva and
food residue in the epiglottic vallecula and the pyriform sinus. For the cases with
tight fibrotic neck skin, we divided this technique into two stages.
Results
All cases could take at least semi-solid food orally, with some minor complications
in the initial four cases. Five cases were independent of tube feeding. Two recent
cases with modifications did not experience any complication and could start oral
intake much earlier (7 days after surgery) than previous cases (118 days on average).
Conclusion
The free jejunal diversionary conduit flaps offer post-radiotherapy patients with
swallowing dysfunction the option to resume oral feeding while preserving their voice
and reducing the risk of aspiration.
Keywords
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Article info
Publication history
Published online: December 23, 2011
Accepted:
November 10,
2011
Received:
October 10,
2011
Footnotes
☆Presented meeting: The Second World Congress for Plastic Surgeons of Chinese Descent in Taipei, Taiwan, 28 October through 31 October 2010.
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
