Free jejunal diversionary conduit flaps following radiation damage to the pharynx: A technique for regaining oral feeding while preserving vocal function

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 eithe...

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Bibliographic Details
Published in:	Journal of plastic, reconstructive & aesthetic surgery Vol. 65; no. 5; pp. 620 - 628
Main Authors:	Atsushi Imaizumi, A.I, Anitaa Liem, A.L, Quand Ngo, Q.N, Hung-Chi Chen, H.C
Format:	Journal Article
Language:	English
Published:	Kidlington Elsevier Ltd 01-05-2012 Elsevier
Subjects:	Adult Aspiration Biological and medical sciences Deglutition Disorders - etiology Deglutition Disorders - surgery Dysphagia Enteral Nutrition - methods Esophagus Female Free jejunal flap Free Tissue Flaps Gastroenterology. Liver. Pancreas. Abdomen Head and Neck Neoplasms - radiotherapy Humans Intubation, Gastrointestinal Jejunum - surgery Male Medical sciences Middle Aged Other diseases. Semiology Pharyngostomy Pharynx - radiation effects Plastic Surgery Postoperative Complications Radiation Injuries - surgery Radiotherapy Reconstructive Surgical Procedures - methods Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome Voice Quality Free jejunal flap Dysphagia Radiotherapy Aspiration Pharyngostomy Esophageal disease Oral administration Pharynx Feeding Jejunum Treatment Surgery Free flap ENT disease Digestive diseases Lesion Technique Voice
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1748-6815 1878-0539
DOI:	10.1016/j.bjps.2011.11.036