Hypopharyngeal pharyngoplasty in the treatment of severe aspiration following skull base tumor removal: experience in pediatric patients.

OBJECTIVE

To report the surgical treatment of severe swallowing disorders associated with skull base surgery resulting in unilateral pharyngolaryngeal paralysis in pediatric patients.

DESIGN

Retrospective case review.

SETTING

Tertiary referral center for pediatric otolaryngology.

PATIENTS

Five infants undergoing swallowing rehabilitation surgery for severe dysphagia and aspiration resulting from skull base or brainstem surgery.

INTERVENTION

A hypopharyngeal pharyngoplasty, consisting of the partial resection of the inferior constrictor and cricopharyngeal muscles, was performed for the treatment of severe swallowing disorders. A thyroplasty was also performed if clinically significant glottic incompetence was present.

MAIN OUTCOME MEASURES

Functional outcomes after surgery were evaluated with a videoendoscopic swallowing study and videofluoroscopy. Postoperative clinical evaluation included respiratory, swallowing, and nutritional outcomes.

RESULTS

A hypopharyngeal pharyngoplasty was performed following a mean period of 6 weeks (range, 1-10 weeks) after skull base surgery. In 3 patients a thyroplasty and a temporary tracheotomy were performed. Oral feeding was reintroduced after a mean period of 6 days (range, 4-20 days). Complete oral feeding autonomy was obtained after 13 days (range, 7-25 days). Postoperative swallowing assessment revealed the disappearance of pharyngeal stasis and aspiration in all patients. Three infants died because of tumor recurrence. Neither dysphagia or bronchopulmonary infections were observed after a mean follow-up period of 33 months (range, 6-61 months).

CONCLUSIONS

Pharyngolaryngeal paralysis represents a severe consequence of skull base and brainstem surgery. This condition leads to high morbidity, particularly in the pediatric population. The hypopharyngeal pharyngoplasty, with a possible thyroplasty, may be considered to treat patients with severe pharyngolaryngeal paralysis after skull base or brainstem surgery.