[Reconstruction of hypopharyngeal cavity with neck reverse rectangular thinned skin flap]

OBJECTIVE

To study the postoperative convalescence of swallow after reconstruction of hypopharyngeal defect with the neck reverse rectangular thinned skin flap.

METHOD

A thinned reverse skin flap was designed in the middle line of a platysma skin flap, and was used in hypopharyngeal reconstruction for 20 patients with squamous cell carcinoma of the hypopharynx.

RESULT

No skin flap complications occurred in all patients. Fistulas in 5 cases healed spontaneously in 7 days to 10 days without further surgery. One case with lower anastomotic site stenosis was performed by subsequent successful surgery. The survival rate was 50% and 33.3% respectively after 3 years and 5 years follow up.

CONCLUSION

This flap was effectively applied for reconstruction of hypopharyngeal defect for hypopharyngeal cancer, which was easy to master by surgeons, and was a high successful procedure of choice.

[Investigation on invasion of preepiglottic space by supraglottic carcinoma]

This study, based on analysis of 100 whole-organ serial sections of the larynx, concluded that preepiglottic space invasion is involved in 60% of supraglottic carcinoma. The preepiglottic space is involved either by invasion through the adjacent structures of the epiglottis, or more frequently by destroying the epiglottic cartilage and the thyro-epiglottic ligament. The preepiglottic space is involved mainly by epiglottic and epiglottic-ventricular carcinomas, accounting for 95% of carcinomas which invade the space. The involvement of preepiglottic space by supraglottic carcinoma is intimately related to the morphologic features, marginal growth patterns, and T classification. Ulcerative carcinoma is the commonest, accounting for 65%. The incidence of the infiltrative carcinomas is the highest. With increase in T stage, the percentage of invasion of preepiglottic space is increased. We believe that the easy invasion of the preepiglottic space by the supraglottic carcinoma is due to the fact that the epiglottic and epiglttic-ventricular carcinomas which account for 83% of supraglottic carcinomas are located in front of the larynx. In addition, the carcinoma easily destroys the epiglottic, cartilage and enters the preepiglottic space because the embryonic barrier which exists below the glottis and the perichondrium of the epiglottic cartilage is quite fragile.