Surgery for Carcinoma of the Posterior Pharyngeal Wall

An approach for resection of carcinoma of the posterior hypopharyngeal wall and a method of repair of the pharynx, which was first described by Trotter, are presented. This exposure and repair can be carried out without sacrifice of the larynx in certain selected patients. This technique was used with preoperative irradiation therapy at a tumorcidal dosage to the primary tumor and 5,000 rads to the neck. A lateral pharyngotomy incision is extended horizontally superior to the hyoid bone. The larynx is rotated to the opposite side. The hypopharynx may be resected from the level of the oropharynx to the cricopharyngeus muscle and from one pyriform sinus to the other. Reconstruction is accomplished with a laterally based skin flap in two stages. With this technique, a functioning larynx is preserved, and the continuity of the upper alimentary tract is reestablished.