Abstract
We report a case of a 61-year-old man with T2N2M0 hypopharyngeal carcinoma. In this case, the right vertical hemipharyngolaryngectomy (VHPL) and the right radical neck dissection were performed. At the same time, flap was taken from the superficial branch of transverse cervical artery for hypopharyngeal reconstruction. Postoperative wound healed smoothly. The patient resumed normal oral intake and was free of the tracheal tube at the 12th and 15th days after surgery, respectively. The superficial branch of transverse cervical artery flap is a new option to successfully reconstruct hypopharynx and has many advantages, such as no additional incision, a thin shape, local transfer, and a reliable blood supply.
1
Introduction
Hypopharyngeal squamous cell carcinoma is one of the most aggressive malignant tumors of the head and neck region. Multidisciplinary treatments applied to overcome this tumor have improved the prognosis of patients, including surgery, radiotherapy and chemotherapy . In order to reestablish the patient’s ability to speak and swallow quickly after the surgery, pharyngolaryngeal reconstruction should be performed in one-stage operation. In this study, we developed the superficial branch of transverse cervical artery flap for reconstruction of hypopharynx. Based on our knowledge, this is the first report of the transverse cervical perforator flap for reconstruction of hypopharynx.
2
Case report
A 61-year-old man complained of pharyngeal pain for 1 month. Laryngoscopy examination showed a mass in the right piriform sinus invading the right aryepiglottic fold. The mobility of the right vocal cord was restrained. Two lymphoid nodes were palpated in his right cervical. Computed tomographic (CT) scan showed a mass in the right pyriform sinus, and it extended to the aryepiglottic fold and the posterior hypopharyngeal wall. There were two lymph nodes found in his right neck. The preoperative biopsy indicated a moderately differentiated squamous cell carcinoma. He was diagnosed as having right pyriform sinus cancer at stage T2N2M0.
The patient underwent right vertical hemipharyngolaryngectomy(VHPL), tracheotomy and right radical neck dissection. The tumor was resected under direct vision with a tumor-free margin of 1 cm. The VHPL included removal of a vertical section of the thyroid cartilage through the anterior commissure to the upper border of the cricoid cartilage. Frozen sections of the surgical margins were negative. The resultant defect of the right lateral pharyngeal wall required reconstruction. A thin perforator flap from the superior branch of transverse cervical artery was designed. The transverse cervical artery was then disclosed and the superficial branch was preserved carefully. In the normal case, the vein is not accompanied with the synonymous artery and it is immerged into the external jugular vein, while the artery in this case is originated in thyrocervical trunk ( Fig. 1 ). It was really a challenge when transferring the flap from the lateral neck to the lateral pharyngeal wall as a result of the tense pedicle of the vein. Then a 4 × 3 cm transverse cervical perforator flap composed of skin and subcutaneous fat was harvested to reconstruct the right piriform sinus ( Fig. 2 ). The flap was transferred to the hypopharyngeal defect and sutured with lateral wall of hypopharynx to cover the defect.
Postoperative wound healed smoothly. The 11th day postoperative laryngoscopic image showed that the flap was located in the right position without stenosis, dehiscence and swelling ( Fig. 3 ). At the 12th day postoperatively, the patient resumed oral intake without accidental inhalation. The tracheal tube was unplugged without dyspnea 15 days after surgery.
2
Case report
A 61-year-old man complained of pharyngeal pain for 1 month. Laryngoscopy examination showed a mass in the right piriform sinus invading the right aryepiglottic fold. The mobility of the right vocal cord was restrained. Two lymphoid nodes were palpated in his right cervical. Computed tomographic (CT) scan showed a mass in the right pyriform sinus, and it extended to the aryepiglottic fold and the posterior hypopharyngeal wall. There were two lymph nodes found in his right neck. The preoperative biopsy indicated a moderately differentiated squamous cell carcinoma. He was diagnosed as having right pyriform sinus cancer at stage T2N2M0.
The patient underwent right vertical hemipharyngolaryngectomy(VHPL), tracheotomy and right radical neck dissection. The tumor was resected under direct vision with a tumor-free margin of 1 cm. The VHPL included removal of a vertical section of the thyroid cartilage through the anterior commissure to the upper border of the cricoid cartilage. Frozen sections of the surgical margins were negative. The resultant defect of the right lateral pharyngeal wall required reconstruction. A thin perforator flap from the superior branch of transverse cervical artery was designed. The transverse cervical artery was then disclosed and the superficial branch was preserved carefully. In the normal case, the vein is not accompanied with the synonymous artery and it is immerged into the external jugular vein, while the artery in this case is originated in thyrocervical trunk ( Fig. 1 ). It was really a challenge when transferring the flap from the lateral neck to the lateral pharyngeal wall as a result of the tense pedicle of the vein. Then a 4 × 3 cm transverse cervical perforator flap composed of skin and subcutaneous fat was harvested to reconstruct the right piriform sinus ( Fig. 2 ). The flap was transferred to the hypopharyngeal defect and sutured with lateral wall of hypopharynx to cover the defect.
