Near-total laryngopharyngectomy with pectoralis major myocutaneous flap in advanced pyriform carcinoma

Successful restoration of phonation, as well as swallowing in laryngopharyngeal surgery for patients with advanced pyriform carcinoma still remains a major challenge. In a five-year period, near-total laryngectomy operations were performed on 21 patients with laryngopharyngeal carcinoma. This report particularly emphasizes the value of near-total laryngopharyngectomy with a pectoralis major myocutaneous flap for four extensive hypopharyngeal carcinoma cases (three of which were of pyriform origin). All four patients regained intelligible shunt speech and smooth swallowing. The follow-up period ranged from 19 to 44 months. They have had no recurrence of disease since surgery. The authors suggest that an advanced pyriform carcinoma case, with a normal contralateral hemilarynx and pyriform sinus, is a candidate for a near-total excision of the laryngopharynx.