[Carcinoma of the hypopharynx: reconstruction of the alimentary canal using the residual larynx].

Treatment of hypopharyngeal carcinoma is difficult and frustrating due to notable problems in reconstruction and because of the low rate of healing. A review of the reconstruction techniques proposed over the last fifty years is given, particularly in regard to those using the residual larynx in reconstructing the alimentary canal. Wookey-type surgery provides for multiple stages and requires long hospital stays; even the reconstruction proposed by Bakamjian requires two operations and is often hampered by a distal necrosis of the deltopectoral flap. The one-stage reconstructions use the abdominal intestine, myocutaneous tubulized flaps and local mucosa flaps made of the tongue, epiglottis and residual larynx stripped of its cartilage. Those techniques using the abdominal intestine have an elevated rate of complications and per-operative mortality, while those using tubulized pectoral myocutaneous flaps at times compress the vascular peduncle due to their thickness, thus leading to post-operative stenosis. In the present work description is given of the hypopharyngeal reconstruction technique using the residual larynx stripped of its cartilage. In cases of cancer of the pyriform sinus the contralateral hemilarynx has been used while, in posterior tumors, the anterior larynx has been used, sutured to the residual posterior mucosa or to a myocutaneous flap. Nine patients underwent surgery using this technique; of these, seven had a tumor of the pyriform sinus, one a retrocricoid tumor and one carcinoma of the posterior wall of the hypopharynx. The oncological results do not appear much different than those obtained with the more well-known techniques, although follow-up is still too short.(ABSTRACT TRUNCATED AT 250 WORDS)