[Anterior diverticulum after total laryngectomy]

CO2 Laser Division of Neo-Vallecula Improves Dysphagia in the Postlaryngectomy Patient: A Case Series and Review of the Literature

Objectives

To review the literature on neo-vallecula diagnosis and management and to report our findings regarding 3 patients who developed neo-vallecula in the context of free-flap pharyngeal reconstruction following total laryngectomy.

Methods

This case series reports three patients who developed a neo-vallecula following a laryngectomy and free-flap pharyngeal reconstruction. All three patients were treated with a CO₂ laser endoscopic procedure.

Results

Neo-vallecula formation is thought to be related to tension on the neopharyngeal closure or closure technique following total laryngectomy. Diagnosis may be obtained with swallow studies, videofluoroscopy, or endoscopy. Treatment has included external excision and endoscopic procedures such as stapling, harmonic scalpel excision, and laser removal. We utilized an endoscopic approach entailing the use of a CO₂ laser to divide the neo-vallecula, and all our patients reported improvement in their dysphagia.

Conclusions

Treatment of an anterior neo-vallecula endoscopically using a CO₂ laser is an effective way to treat dysphagia in patients following total laryngectomy with free-flap pharyngeal reconstruction.