The anatomy and complications of "T" versus vertical closure of the hypopharynx after laryngectomy.

The early postoperative hypopharyngeal anatomy of 37 consecutive patients undergoing total laryngectomy at the Boston Veteran's Administration Hospital between July 1977 and April 1980 was studied by barium swallow radiographs and correlated with the technique of closure. The "pseudoepiglottis," a structure radiographically resembling a normal epiglottis, was seen arising from the anterior hypopharynx near the base of the tongue in 21 of 28 evaluable patients. It occurred in all patients with vertical closures vs. 67% of patients with a "T" shaped closure. The average length in the "T" closure group was 9.6 mm (range 0-35) vs. 18.4 mm (6-40) in the vertical group, a statistically significant difference (p less than 0.05). Radiologic strictures occurred in 39% of all patients, dysphagia in 29%, fistulae in 18%, and sinus tracts in 14%. All complications occurred more frequently in the vertical closure group. Patients who received preoperative cis-platinum bleomycin chemotherapy and postoperative irradiation had 50% dysphagia and 67% stricture rates. The average ratio of the width of the retropharyngeal space to that of C4 was 0.48 in stricture patients vs. 0.29 in non-stricture patients (statistically significant at the p less than 0.01 level). This ratio taken in the early postoperative period may help predict which patients will develop strictures.