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Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: To investigate the use of folded flap for repair of laryngeal and hypopharyngeal defect and the clinical efficacies of laryngeal and hypopharyngeal function reconstructions after surgery of piriform sinus cancer. Methods: A retrospective analysis was performed for 10 cases of piriform sinus cancer that were treated in the Second Norman Bethune Hospital of Jilin University from January 2020 to April 2023 and all patients were males, aged 42-68 years. The first choice of treatment for all patients was surgery. After function neck dissection and tracheotomy, partial laryngectomy and hypopharyngectomy were carried out. The folded island flaps were prepared and used for the repairs of laryngeal and hypopharyngeal defects and the reconstructions laryngeal and hypopharyngeal functions. The patients were followed up. Results: The laryngeal and pharyngeal cavities were reconstructed well in 10 patients, and all the flaps survived, with no case of pharyngeal fistula. All patients were able to eat normally through the mouth at 2 weeks after surgery without obvious choking, and 4 patients completed the swallowing function evaluation without aspiration or only a small amount of aspiration. All the 10 patients underwent postoperative radiotherapy. The postoperative follow-up time was 5.4-41.4 months, and there was no case with tumor recurrence or death. Laryngoscopy showed that 8 patients had a spacious new laryngeal orifice, which met the conditions for extubation, of whom 7 patients had their tracheal tubes removed and 1 patient was still under observation, and that 2 patients had a slightly narrowed new laryngeal orifice due to a thick skin flap, with further follow-up observation. All patients retained their phonatory functions after surgery. Conclusion: Folded island flap can be used for the function reconstructions of the larynx and hypopharynx after surgery of pyriform sinus cancer.

Objective: The study aimed to identify factors affecting the management and prognosis of iatrogenic cervical oesophageal and hypopharyngeal perforations (iCEHPs)., Methods: We retrospectively analysed 24 patients treated for iCEHP between 2004 and 2021 at a tertiary university medical centre. Data on demographics, clinical features, imaging, management and outcomes were collected. Factors associated with primary management and patient outcome were assessed., Results: The most common management approach was surgical neck exploration (15 patients, 62.5%). Surgical management was used in 93% of uncontained perforations compared to 11% of contained perforations (p < 0.001). Surgically-treated patients had higher levels of C-reactive protein (CRP) than conservatively-treated patients (median, 18.3 vs 4.8 mg/dL; p = 0.001). Delayed diagnosis (≥ 24 hours) was associated with increased mortality (100 vs 5%; p = 0.011). The mortality rate was significantly higher in patients who had a history of neck irradiation than in patients who did not (67 vs 5%; p = 0.032)., Conclusions: Early diagnosis of iCEHP improves outcomes. The appropriate management should be carefully selected on the basis of CRP level and imaging findings. Prior neck radiation is a poor prognostic factor., (Copyright © 2024 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objectives: To assess potential risk factors influencing diet outcomes after reconstruction of subtotal hypopharyngeal defects using free patch- or tube-shaped anterolateral thigh (ALT) fasciocutaneous flaps., Study Design: Retrospective cohort study., Setting: First-level referral hospital., Methods: Between January 2011 and December 2020, we studied hypopharyngeal cancer patients who underwent the reconstruction of hypopharyngeal defects using free patch- or tube-shaped ALT fasciocutaneous flaps. The choice between patch- or tube-shaped ALT flaps depended on the defect's nature, favoring patch-shaped for subtotal defects and tube-shaped for circumferential defects. A restricted diet was characterized by a history of enterostomy or endoscopic esophageal dilation treatment postreconstruction. We analyzed patients with restricted diets at 1- and 3-year follow-up visits., Results: Ninety-eight patients were enrolled; 39 patch-shaped flaps, and 59 tube-shaped flaps. No significances were noted in demographics, postoperative radiotherapy (RT) or chemotherapy, rates of free flap reoperation/salvage, or complications. However, a significant difference emerged in diet outcomes at the 1-year follow-up (P = .005). The rate of a restricted diet was 6.08 times higher in patients with tube-shaped flaps compared to patch-shaped flaps (95% confidence interval [CI]: 1.95-18.94). Stratifying based on postoperative RT revealed a 5.47 times higher rate of a restricted diet in tube-shaped flap recipients compared to patch-shaped flap recipients (95% CI: 1.44-20.48). No significances were observed in 5-year survival rates., Conclusion: Concerning postoperative RT, patch-shaped flaps exhibited a lower incidence of a restricted diet compared to tube-shaped flaps. Preservation of the posterior mucosa may play a crucial role in preventing RT-induced esophageal stricture., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: To investigate the feasibility, safety and effectiveness of colonic interposition with vascular anastomosis in reconstructing the entire esophagus and hypopharynx after resection of hypopharyngeal cancer with esophageal cancer. Methods: We conducted a retrospective analysis of 4 male patients with simultaneous multiple primary cancers of the hypopharynx and esophagus, aged 47 to 58, treated in the Department of Head and Neck Surgery at the Hunan Cancer Hospital from February to August 2019. All cases underwent total hypopharyngectomy and total esophagectomy, of whom, three cases presented with total laryngectomy and one case with larynx preservation. Colonic interposition was performed using the left colic artery as a pedicle, with an average colonic length of 48.5 cm. The colon was elevated through the esophageal bed to the neck, and the branch of the colonic mesenteric artery was anastomosed to one of the neck arteries, including the inferior thyroid artery in one case, the transverse cervical artery in two cases, and the superior thyroid artery in one case, and all venous anastomoses were performed with the internal jugular veins. Results: The postoperative neck and abdominal wounds healed well without anastomotic leakage, and all patients were able to resume a regular oral diet within 21-30 days postoperatively. During the follow-up of 48-52 months, two cases died due to tumor recurrence, while the remaining two cases were disease-free survivals. Conclusion: Colonic interposition with vascular anastomosis is a safe and reliable reconstruction method suitable for repairing long-segment upper digestive tract defects after resection of hypopharyngeal cancer with esophageal cancer.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: It remains unclear whether a tubed fasciocutaneous or jejunal free flap (FCFF and JFF) is preferable for reconstruction of circumferential pharyngolaryngoesophageal defects., Methods: All consecutive patients with circumferential pharyngolaryngoesophageal defects reconstructed with an FCFF or JFF between 2000 and 2022 were included. Outcomes of interest were rates of fistulas, strictures, and donor-site complications., Results: In total, 112 patients were included (35 FCFFs and 77 JFFs). Fistula and stricture rates were significantly lower following JFF compared to FCFF reconstructions, with 12% versus 34% (p = 0.008) and 29% versus 49% (p = 0.04), respectively. Severe donor-site complications leading to surgical intervention or ICU admittance only occurred after JFF reconstructions (18%, p = 0.007)., Conclusions: The high fistula and stricture rates in FCFF reconstructions and the rate of severe abdominal complications in JFF reconstructions illustrate inherent procedure-specific advantages and disadvantages. Relative pros and cons should be carefully weighed when tailoring treatments to the individual needs of patients., (© 2024 The Authors. Head & Neck published by Wiley Periodicals LLC.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Locally advanced laryngeal cancers treatment often involves total laryngectomy, which some patients are unwilling to undergo, even if this choice reduces their survival probability. Therefore, the objective of laryngeal oncologic surgery is not only to remove the tumor, but also to preserve the organ and its functions. To overcome these concerns, several partial laryngectomy techniques have been developed. This article describes the surgical technique and a case study of a 64-year-old male patient with locally advanced laryngeal squamous cell carcinoma who underwent vertical partial laryngectomy extending to the subglottis and hypopharynx using transoral robotic surgery (TORS) with a da Vinci Single Port surgical robot. The video and article provide a detailed description of the surgical technique, which resulted in successful tumor removal with excellent oncological and functional outcomes., (© 2024 Wiley Periodicals LLC.)

To explore the clinical diagnosis and treatment experience of isolated fibrotic tumor （SFT） occurring in the larynx, hypopharynx and esophageal inlet with a wide range.The patient, admitted to the Department of Otolaryngology-Head and Neck Surgery of Tangdu Hospital of Air Force Medical University was a female aged at 78 years, who was diagnosed with SFT primarily occured at laryngeal, hypopharynx and esophageal entrance. The clinical data, surgical methods, histopathology characteristics of the patient were analyzed respectively. It's proved that a tumor sized about 3.8 cm×2.8 cm×2.0 cm with slippy surface was found at the entrance of the laryngeal, hypopharynx and esophageal entrance, covering the laryngeal vestibule, glottis and right piriform fossa, which was completely resected by transoral robotic surgery. The postoperative pathological diagnosis was SFT. The patient recovered well after surgery and showed no recurrence within 16-month follow-up. SFT occurring in the larynx, hypopharynx, and esophageal inlet is very rare, and transoral da Vinci robotic surgical resection of the tumor in this area is feasible, and has the advantages of clear field of vision, less bleeding, less trauma, fewer complications, and quicker postoperative recovery., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Well-differentiated neuroendocrine tumor, Grade 1 (NET, G1), in the hypopharynx is extremely rare. A 62-year-old woman was referred to our clinic with a tumor in the postcricoid area. The tumor was diagnosed NET on biopsy and there were no metastatic findings on CT, therefore we performed endoscopic resection. Histologic examination revealed well-differentiated neuroendocrine tumor, Grade 1. This case was an extremely rare and valuable case in which endoscopic images can be observed in detail. Endoscopic resection was performed and successful endoscopic and histological resection was achieved., (© 2023. Japanese Society of Gastroenterology.)

Objective: To explore the feasibility of using self-made visual throat forceps to remove hypopharyngeal foreign bodies. Methods: The throat forceps were combined with the endoscope and connected to a monitor via a data cable resulting in a visual throat forceps apparatus. This device was utilized to examine and treat the hypopharyngeal foreign bodies. Results: Among 53 patients, foreign bodies were detected in 51,with 48 cases involving hypopharyngeal foreign bodies. All were successfully extracted using the visual throat forceps. Three cases, diagnosed as esophageal foreign bodies by electronic gastroscopy, were treated using the same method. Conclusion: Visual throat forceps can be used to examine the hypopharynx and remove foreign bodies. It has the advantages of simple operation, rapid operation, and high success rate of foreign body removal from the hypopharynx. It is worthy of clinical application., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Competing Interests: Andrea Tringali is a consultant for Boston Scientific and Olympus. Ivo Boškoski is a consultant for Apollo Endosurgery, Boston Scientific, Cook Medical, Nitinotes, Endo Tools, Micro Tech and Pentax; research grant Apollo Endosurgery, advisory board member Endo Tools. Guido Costamagna receives consulting fees from Cook Medical, Olympus, Boston Scientific Corp.

Objective: Da Vinci single port (SP) has been recently approved for transoral robotic surgery (TORS). Its characteristics make it particularly feasible for laryngeal and hypopharyngeal surgery. We report our experience comparing intra- and postoperative outcomes, technical advantages, and shortcomings of transoral laryngeal and hypopharyngeal resections performed with the da Vinci SP and the da Vinci Si/Xi systems., Study Design: Retrospective database review., Setting: Single academic tertiary care hospital., Methods: Subjects included adult patients with laryngeal and hypopharyngeal carcinoma who underwent TORS between 2008 and 2022. The SP and multiport (MP) systems were compared in terms of intraoperative times, short-term postoperative outcomes, and TORS-related complications after a propensity score matching., Results: A total of 185 patients were enrolled (56 SP vs 129 MP patients), and a cohort of 112 patients was analyzed after matching. The docking time was reduced in the SP group (8.84 ± 4.67 vs 6.45 ± 3.11 minutes; p = .003), as well as console time (53.91 ± 29.38 vs 42.70 ± 13.72 minutes; p = .035). Positive margins were more frequent in the MP group (52% vs 43%; p = .34). The mean decannulation time was 1.86 days longer in the SP group (p = .046). No significant differences emerged from the analysis of the duration of hospitalization, enteral feeding, and TORS-related complications., Conclusion: SP safety profile is comparable to that of previous models, while it showed advantages in terms of reduced docking times. Console times were also shortened due to improved maneuverability and field visualization., (© 2023 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)

Background: The treatment of refractory hypopharyngeal corrosive strictures remains challenging nowadays., Objectives: To introduce a designed ladder-shaped stent for the treatment of refractory hypopharyngeal corrosive strictures., Material and Methods: Patients with refractory hypopharyngeal corrosive strictures treated in our hospital between 2018 to 2022 were recruited in this study. All the patients had a dysphasia score of 4 and four patients had a tracheostomy preoperatively. A designed ladder-shaped stent was placed in the hypopharyngeal area after laser treatment to maintain the opening. This stent was kept for 3-6 months. All the patients were followed-up for at least 6 months after stent removal., Results: Six patients were recruited including two males, three females and one girl. All the patients were tolerable with the stent. There were no immediate or long-term complications. Patients were able to swallow a soft diet after the procedure. No tracheostomy was needed., Conclusion: This use of a ladder-shaped stent is helpful in the treatment of hypopharyngeal strictures after laser treatment.

We describe the case of a patient who swallowed a small fish bone and felt it lodge in her pharynx, but failed to seek medical attention in a timely manner. One week later, no foreign body was found in the hypopharynx or larynx, but a small purulent cyst was present in the epiglottic vallecula. A computed tomography scan showed a high-density area on the lingual surface of the epiglottis, which was considered to represent an embedded fish bone. A week later, the patient's discomfort had subsided, and flexible videoendoscopy showed that the purulent cyst in the epiglottic vallecula had disappeared. We surmise that the purulent cyst had ruptured spontaneously and the foreign body had been discharged. This represents an example of how an impacted small foreign body may be spontaneously discharged from the body.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objectives: Hypopharyngeal and laryngeal cancers are aggressive and usually diagnosed at advanced stage with esophagus invasion. Total pharyngolaryngoesophagectomy with gastric pull-up reconstruction has been a common surgery for these cancers but long-term outcomes are still questionable. This study aimed to investigate short-term and long-term outcomes of patients who underwent this surgery., Methods: Patients with hypopharyngeal or laryngeal cancer invading cervical esophagus who underwent total pharyngolaryngoesphagectomy with gastric pull-up between 2012 and 2016 was included and followed up until 2021. Short-term outcomes were complications and long-term outcomes were overall survival (OS) and disease-free survival (DFS)., Results: Fifty patients were included with a mean age of 60.3 years and 94% were male. Pyriform fossa was the most common primary site of tumor (50%), followed by posterior hypopharyngeal wall (18%) and postcricoid region (18%). Mean operating time, postoperative oral intake and hospital stay was 363.1 ± 43.6 minutes, 8.8 ± 3.6 days and 14.2 ± 3.0 days respectively. Complications occurred in 15 patients (30%) without any in-hospital death. During the follow-up period, 17 patients had recurrence and 35 patients died. Median (95% confidence interval [CI]) OS and DFS time were 30 (21-37) and 30 (19-36) months. Five-year OS and DFS probability (95% CI) were 22.6% (12.8-39.7) and 22.7% (12.9-39.8)., Conclusions: Total pharyngolaryngoesophagectomy with gastric pull-up is feasible and safe. However, even with curative surgery and multimodal treatment, advanced pharyngeal or laryngeal cancer with cervical esophagus invasion still has poor survival outcome.

Salivary Bypass Tube is an important tool to prevent or treat some complications of laryngeal and hypopharyngeal surgery and its placement may prove difficult. In this article, we propose a new technique to simplify its management by using an Oral/Nasal Tracheal Tube Cuffed-Reinforced that allowed us to reduce operating times, complications related to prolonged general anesthesia, and the traumas on the tissues incurred during the forced positioning of the device with standard techniques.

Competing Interests: The authors declare that they have no conflict of interest.

Hypopharyngeal liposarcomas are extremely rare. Due to the lack of experience, pathologists and surgeons find it difficult to make a clear diagnosis and provide accurate, timely treatment. A 43-year-old man with a complaint of foreign body sensation in the throat for 6 months and swallowing difficulty for 2 months was admitted to our department. Contrast-enhanced computed tomography of the chest and larynx revealed a lesion with smooth surface in the esophagus, connected by a pedicle to the hypopharyngeal lesion. The same result was found by gastroscopy. Lateral pharyngotomy was performed for tumor removal, and after 3 weeks, the patient showed good movement of bilateral vocal cords, without dysphagia, choking cough, or hoarseness. This is the first case report of hypopharyngeal liposarcoma invading the esophagus. A thorough preoperative evaluation may be required for the proper diagnosis, prevention, and treatment.

Background: Advanced malignant neoplasms of the larynx and hypopharynx pose many therapeutic challenges. Total pharyngolaryngectomy and total laryngectomy provide an opportunity to cure these tumours but are associated with significant morbidity. Reconstruction of the pharyngeal defect following total pharyngolaryngectomy demands careful consideration and remains an area of debate within surgical discussions., Methods: This paper describes a systemic analysis of pharyngeal reconstruction following total pharyngolaryngectomy and total laryngectomy, leveraging data collected over a 20-year period at a large tertiary referral centre., Results: Analysing 155 patients, the results show that circumferential pharyngeal defects and prior radiotherapy have a significant impact on surgical complications. In addition, free tissue transfer in larger pharyngeal defects showed lower rates of post-operative anastomosis leak and stricture., Conclusion: Pharyngeal resection carries a substantial risk of post-operative complications, and free tissue transfer appears to be an effective means of reconstruction for circumferential defects.

Introduction: Non-response to palatal surgery for OSA is a problem. Residual lateral wall hypopharyngeal collapse is the proposed mechanism of failure., Objective: This study aims to evaluate the role of transpalatal advancement pharyngoplasty in non-responders to primary palatal surgery with residual lateral wall hypopharyngeal collapse., Methods: This is a retrospective study that was conducted on patients who underwent transpalatal advancement pharyngoplasty for residual lateral wall hypopharyngeal. Inclusion criteria were age greater than 18-years, OSA proved by the polysomnography with apnea hypopnea index >15, lateral wall collapse at the level of hypopharynx as proved by drug-induced sleep endoscopy and had a previous tonsillectomy or previous palatal surgery for OSA. Exclusion criteria were those with no history of tonsillectomy or any other surgery for OSA and those with a missed followup. Data of included patients were collected and included gender, age, polysomnographic data like the apnea hypopnea index, oxygen desaturation and the calculated preoperative Epworth sleepiness scale. The early outcome included symptom improvement as measured by Epworth sleepiness scale score and lateral pharyngeal wall evaluation by nasopharyngoscopic examination in the first postoperative month. Late outcome measurement was performed by the 6-month postoperative polysomnography. Data were analyzed using SPSS program., Results: The study included 37 patients with a mean age of (40.43 ± 6.51). The study included 26 men and 11 women. There was a statistically significant improvement of apnea hypopnea index from 37.8 ± 9.93 to 9.9 ± 2.55. In addition, a statistically significant improvement of lowest oxygen saturation from 78.9 ± 3.39 to 83.3 ± 3.31 was encountered. The patients improved clinically, and this improvement was measured by statistically significant improvement of Epworth sleepiness scale score and snoring visual analogue scale., Conclusion: Transpalatal advancement pharyngoplasty widens the retropalatal airway and has a great role in the management of the vertical palate phenotype. In addition, it can have a role in the management of lateral walls, especially lateral wall hypopharyngeal collapse., (Copyright © 2021 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Introduction: Reconstruction of expanded hypopharyngeal defects following laryngo-hypopharyngectomy for surgical treatment of primary is still a challenge for head and neck surgeons. Tradiotionally, jejunal or radial forearm flaps are the common reconstructive choice. Recently, the anterolateral thigh (ALT) free flap has served for pharyngoesophageal reconstruction. The goal of this work is to describe a retrospective analysis about a five-year single-center experience in the reconstruction of post-operative hypopharyngeal defects with ALT free flap., Methods: A single-center retrospective study was performed, including patients treated for patients who underwent tumor surgery involving hypopharynx with ALT free flap reconstruction from 2015 to 2020. Exclusion criteria were paediatric (0-18 years) patients, and the absence of follow-up., Results: The study included 23 adult patients. The mean size of the flap was 90 cm 2 (range 60-130 cm 2 ). The mean time required to harvest the antero-lateral tight flap was 70 min (range 35-120 min). The median age was 46.3 years (SD 15.81, range: 19-84 years), with a gender female prevalence (F = 48, M = 33). Mean follow-up was 77.7 months (min 4-max 361, SD 72.46). One patient (4.4 %) showed a hypopharyngeal stenosis., Conclusion: ALT free flap represents a successful and versatile reconstructive option for hypopharyngeal defects extended to oropharynx and/or larynx following total laryngectomy with circumferential or partial hypopharyngectomy, regardless of the functional and aesthetic results, with minimal donor-site complication., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The anterolateral thigh (ALT) flap is a popular choice for head and neck reconstruction surgery, but its ungainly thickness makes it of limited value in some intracavitary reconstructions. The ALT adipofascial flap is an improved flap without skin or muscle. Here, we seek to further illustrate the ALT adipofascial flap as an alternate method of hypopharyngeal and oropharyngeal reconstruction in head and neck., Methods: A retrospective review of 9 patients (7 men, 2 women) ranging from 28 to 67 years (mean age, 53.1 years) who underwent reconstruction with the ALT adipofascial flap after hypopharyngeal carcinoma (4 patients) or oropharyngeal carcinoma (5 patients) resections from August 2018 to December 2019 was performed. Surgical outcomes and functional resoration were assessed., Results: The size of the flaps ranged from 6 × 4 cm 2 to 6 × 12 cm 2 . The average flap thickness was 0.14 cm (range, 0.1-0.2 cm) and the average pedicle length was 9.8 cm (range, 7-12 cm). The postoperative course was uneventful in eight patients. Reconstruction was successful in all cases during 7-23 months of follow-up (mean time, 14.3 months). All patients resumed oral feeding for 2-8 weeks (mean time, 4.9 weeks) and the tracheal cannula was successfully removed 0.5-4 months postsurgery (mean time, 2.4 months)., Conclusion: The ALT adipofascial flap is a viable choice for hypopharyngeal and oropharyngeal reconstructions and is thinner than the ALT flap. It could be harvested as a single-pedicled double-island flap for complex defect reconstruction., (© 2022 Wiley Periodicals LLC.)

Objective: To present a case of a ballistic foreign body in the pharynx after a gunshot wound to the maxillofacial area, an accompanying review of relevant literature, and our approach to management., Method: A 68-year-old male with no prior medical history presented to our trauma center with gunshot wounds to the left chin, left wrist, right chest, and sternum. A CT Angiogram of the neck revealed a bullet fragment left neck and additional fragment adjacent to the L hypopharynx at the level of the hyoid. The patient was taken to the operating room for direct laryngoscopy with foreign body removal and esophagoscopy., Results: We document our workup and successful surgical removal of the pharyngeal ballistic foreign body via our video abstract, compiling preoperative imaging, intraoperative imaging, and video. Literature review of the subject accompanying our video abstract highlights the extensive complications that can occur from a retained foreign body in this area, supporting surgical removal of the foreign body if safely possible., Conclusion: Given the demonstrated feasibility and success of endoscopic foreign body removal from the pharyngoepiglottic space, in addition to overwhelming support for removal in the literature we recommend surgical extraction of ballistic foreign bodies located in the upper aerodigestive tract in stable patients to avoid early and long-term complications that can impact swallowing function, airway stability and the vital structures contained within the neck., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to report for this work., (Copyright © 2022. Published by Elsevier Inc.)

Background: Reconstruction of a pharyngoesophageal defect remains a challenging problem, especially with involvement of the neck skin. This study aimed to demonstrate the surgical technique of utilising a butterfly modification of the anterolateral thigh flap., Results: Reconstruction of the pharyngoesophageal defect was accomplished using the butterfly modification of the anterolateral thigh free flap. The flap was tubed on the leg while still being attached to the pedicle, to minimise the ischaemia time., Conclusion: Butterfly anterolateral thigh free flap allows for multi-layer closure of the neopharynx and can be utilised for reconstruction of pharyngoesophageal and neck skin defects.

We present a new oral intake route in a hypopharyngeal cancer patient with severe complications. A 64-year-old man was diagnosed as having T2N0M0 squamous cell carcinoma of the posterior wall of the hypopharynx. He had previously undergone radiotherapy for laryngeal cancer and tricuspid valve replacement surgery, and also had atrial flutter and renal dysfunction. We performed surgery with curative intent. The hypopharynx was primarily closed after tumor resection. Laryngotracheal separation and tracheoesophageal diversion with end-to-end anastomosis of the trachea to the esophagus was performed. After surgery, complete oral feeding was achieved using the new pathway created. The larynx, contradictory to its typical role, can be used as a pathway to the esophagus using our revolutionary technique., Competing Interests: Declaration of Competing Interest The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2021. Published by Elsevier B.V.)

Objectives: Because of its peculiar anatomical location, most patients with hypopharyngeal and cervical esophageal cancer are at advanced stage when they visit the hospital. At present, the treatment for hypopharyngeal and cervical esophageal cancer is primarily surgical resection and radiotherapy. However, due to the wide range of surgical resection, it can often lead to a large range of annular defects. Therefore, the upper digestive tract reconstruction after tumor resection is very important. We use the free anterolateral thigh flap (ALT) and free jejunum (FJ) transfer to reconstruct the hypopharyngeal and cervical esophagus, and to investigate the effect of both reconstruction methods on upper gastrointestinal tract defects., Methods: A retrospective analysis was conducted to investigate the clinical data of 42 patients with hypopharyngeal and cervical esophageal cancer (Clinical Stage IV) from Jan. 2004 to Jan. 2016 in the Second Xiangya Hospital of Central South University. All patients underwent total laryngopharyngectomy and cervical esophageal resection. The hypopharyngeal circumferential and cervical esophageal defects were reconstructed with free ALT ( n =22) or FJ ( n =20). Four patients who underwent radiotherapy and chemotherapy before surgery did not receive radiotherapy or chemotherapy after surgery. The remaining 38 patients underwent postoperative radiotherapy and chemotherapy. All patients were followed up by telephone or outpatient review, with a follow-up deadline in Jan. 2021. We compared the differences between the 2 groups in postoperative complications, radiotherapy complications, and survival rate. The differences in individual characteristics between 2 groups were analyzed using Fisher test. The differences in postoperative and radiotherapy complications between two groups were analyzed using χ² test. The 3- and 5-year overall survival rates were calculated using Kaplan-Meier survival curve method., Results: In the ALT group, the postoperative complications mainly included anastomotic fistula, chylous fistula and subcutaneous hematoma of the donor site. The radiotherapy complication was anastomotic stenosis. However, in the FJ group, the postoperative complications mainly included chylous fistula, intestinal obstruction, and intestinal fistula. The radiotherapy complications mainly contained anastomotic fistula and tissue flap necrosis. The cases of postoperative complications in the ALT group and the FJ group were 7 and 5, respectively ( P =0.625), and the cases of radiotherapy complications were 3 and 4, respectively ( P =0.563). The 3-year overall survival rates in the ALT group and the FJ group were 52.9% and 46.7%, respectively, and the 5-year total survival rates were 35.1% and 31.9%, respectively ( P =0.53). The cases of anastomotic stenosis after radiotherapy in the ALT group were more than those in the FJ group ( P =0.097). However, the cases of jejunal necrosis and anastomotic fistula after radiotherapy in the FJ group were more than those in the ALT group ( P =0.066)., Conclusions: There are no significant differences in postoperative and radiotherapy complications and 3-and 5-year survival rates between the ALT group and the FJ group. The reconstruction with ALT is prone to develop anastomotic stricture. The reconstruction with FJ cannot withstand high-dose radiotherapy. The ALT and FJ are effective methods in the reconstruction of hypopharynx and cervical esophagus. The treatment protocol should be carefully chosen based on its advantages and disadvantages of these 2 methods.

Background: Fibrovascular polyps (FVPs) with hypopharyngeal pedicles (hFVPs) are the rare intraluminal benign tumours of the upper aerodigestive tract, and their accurate diagnosis and optimal management are challenging. Purpose: The present retrospective study attempted to explore the optimal diagnosis and treatment of hFVPs. Research Design: The clinical records of 2 patients with giant, irregularly shaped hFVPs, who underwent several failed surgical procedures after inaccurate diagnosis, were reviewed. Finally, the patients were correctly diagnosed and successfully treated at Capital Medical University Beijing Friendship Hospital in different years, 2018 and 2020. Results: Case 1 was of a 43-year-old woman with 2 months of progressive dysphagia. Gastroenterologists overlooked the origin of her FVP, and decided to sever its narrowest point in the oesophagus through endoscopy. However, upon unsuccessful removal of the mass, a gastrotomy procedure was performed to extract the mass 7 days later. Symptoms recurred 3 months after the treatment, and a fibreoptic laryngoscopy confirmed hFVP in the patient at our department. A transcervical approach was used to sever the hypopharyngeal pedicle, achieve haemostasis and remove the oesophageal tumour. No recurrence was detected during the 2-year follow-up period after the treatment. Case 2 was of a 32-year-old man with dysphagia who had previously undergone transthoracic and transcervical oesophagotomy procedures within a gap of 3 months for the removal of FVP causing dysphagia. The hypopharyngeal pedicle was not diagnosed in the patient. The symptoms of dysphagia recurred 4 years after the treatment, and a fibreoptic laryngoscope confirmed hFVP at our department. The tumour was removed successfully through the transcervical approach. No recurrence was detected during the 6-months follow-up after surgery. Conclusion: In conclusion, the transcervical approach is suitable for achieving haemostasis and removing giant, irregularly shaped hFVPs.

Background: Hypopharynx reconstruction after hypopharyngectomy is still a great challenge. Perfusion decellularization is for extracellular matrix (ECM) scaffolding and had been used in organ reconstruction. Our study aimed to prepare an acellular, natural, three-dimensional biological hypopharynx with vascular pedicle scaffold as the substitute materials to reconstruct hypopharynx., Result: Scanning electron microscope and histology staining showed that the decellularized hypopharynx with vascular pedicle scaffold retained intact native anatomical ECM structure. Myoblasts were observed on the recellularized scaffolds with bone marrow mesenchymal stem cells induced by 5-azacytidine implanted in the rabbit greater omentum by immunohistochemical analysis., Conclusion: The decellularized hypopharynx with vascular pedicle scaffold prepared by detergent perfusion in our study has a potential to be an alternative material to pharynx reconstruction., (© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Background and Aims: The management of patients with hypopharyngeal or cervical esophageal refractory benign strictures (RBS) after surgery and radiotherapy ± chemotherapy for laryngeal cancer is challenging. We aimed to assess the long-term efficacy and safety of a new designed fully covered SEMS in these patients., Methods: We reviewed the results of a prospectively collected database of 40 consecutive patients with dysphagia due to RBS of the cervical esophagus or hypopharynx after surgery and radiotherapy with or without chemotherapy for laryngeal cancer, unfit for surgery, referred in two tertiary-care endoscopic centers from June 2005 to December 2018. All of them were treated with placement of a Niti-S Conio cervical stent., Results: After placement of the first stent, dysphagia improved in all patients. The total number of adverse events was 35 out of a total of 299 procedures (11.7%): 25 (8.4%) stent migrations, 6 (2%) tumor overgrowth, 3 severe pain and 1 pharyngo-cutaneous fistula. Stents were periodically changed. In only one patient with a cervical esophageal stricture the stent was definitively removed after 7 sessions of stent placement because of stricture resolution. Patients were followed-up for a median of 11.6 months and a significant improvement in dysphagia was reported in all patients (p < 0.001)., Conclusions: The use of this conformable, small caliber new designed Niti-S stent, exchanged periodically, appeared safe and permitted durable oral intake in patients with difficult-to-treat hypopharyngeal or cervical esophagus strictures, avoiding the need for periodic dilations., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Posterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma., Objectives: To report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap., Methods: The study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed., Results: Nine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10-21 days). All patients achieved oral intake in a median time of 74 days (range, 15-180). Decannulation was achieved in all patients and the median time for decannulation was 90 (range, 21-300 days). The mean followup duration was 38.3 months (range, 10-71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis., Conclusion: Primary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap., (Copyright © 2020 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Hypopharyngeal carcinoma is usually present at late stages, necessitating an aggressive line of management consisting of surgical procedures, chemotherapy, and radiation therapy, depending on the case. Practitioners tend to support total laryngectomies or total esophagostomies for most cases of hypopharyngeal carcinoma. The extensive procedures needed will most probably require, depending on the residual defect, a follow-up reconstructive procedure that might require utilizing flaps. Types of reconstructive methods and types of grafts or flaps used could be divided into a multitude of categories depending on the magnitude, shape, extension, and whether the underlying defect that is being reconstructed is circumferential or not. These reconstructive procedures are aimed at improving the quality of life, improving the aesthetic outcome, and restoring the functionality of the pharyngoesophageal segment. When it comes to hypopharyngeal cancer, the most common kind is squamous cell carcinoma (SCC), which has the worst prognosis of all the head and neck malignancies. Overall, the 5-year survival rate remains low, despite recent advancements in diagnostic imaging, radiation, and chemotherapy, as well as enhanced surgical methods and techniques. Hypopharyngeal malignancies are more probable than other tumors to present with advanced primary illness, with nodal metastasis a distinct possibility. The size and amount of local dissemination of the original carcinoma, as well as the extent of involvement of regional lymph nodes, are the most critical factors in predicting prognosis. Hypopharyngeal cancers are more likely than other head and neck cancers to manifest with distant metastases at the time of diagnosis. The appearance of second primary tumors, as well as the development of distant metastases, is a contributing factor to poor survival rate. Imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) with contrast remain the gold standard for evaluating hypopharyngeal carcinoma in the early stages. In most cases, imaging leads to an increase in the tumor stage at the time of presentation. Objectives . The main objectives are to review the research published about flaps, outline the optimum situations that will dictate the usage of a few of the most often used flaps for the rebuilding of the hypopharyngeal segment defects, and outline some of the complications associated with reconstruction. Methods . The processing was carried out with the title-specific search of the PubMed database using the query terms "hypopharyngeal carcinoma" and "reconstruction" to identify the most relevant articles without restricting publication dates. Information about the types of defects and methods of reconstruction was extracted from the reviewed articles. Two books were also reviewed, which were Regional and Free Flaps for Head and Neck Reconstruction (second edition) and Head and Neck Reconstruction: A Defect-Oriented Approach. Conclusion . Deciding the appropriate approach to a case should be individualized and should depend on the capabilities of the center, the defect's size and status, and lastly, the surgeon's training. The use of interpretation in the diagnosis of flaps can offer the best results in restoring functionality and vascularity and might also offer improved cosmesis., Competing Interests: The authors declare that there are no conflicts of interest with this study., (Copyright © 2022 Hani Marzouki et al.)

Objectives/hypothesis: To evaluate the clinical utility of postoperative contrast x-ray pharyngograms (XRP) for detecting pharyngoesophageal leaks following hypopharyngeal dysphagia surgery., Study Design: Retrospective cohort study., Methods: Medical records were reviewed of patients undergoing endoscopic (E-) or open (O-) Zenker's diverticulectomy (-ZD) with cricopharyngeal myotomy (-CPM) and CPM alone from 2008 to 2020 at one academic institution. Exclusion criteria were patients who were fed enterally or underwent repair of epiphrenic diverticula or O-CPM during laryngectomy. XRP clinical indication, impact on clinical care, and factors associated with use patterns were examined using descriptive statistics and logistic regression (LR)., Results: Of 152 subjects, 52% underwent O-ZD, 30% O-CPM, 15% E-ZD, and 3% E-CPM. An XRP was ordered for 65% of subjects, mostly routinely (94%). Among the four clinically apparent leaks observed in this cohort, early postoperative XRP confirmed one. It did not identify any clinically silent leaks. In univariate LR, undergoing XRP was associated with increasing day of diet advancement (odds ratio [OR] 4.7, 95% confidence interval [CI] 2.5-10.5) and hospital stay duration (OR 3.2, 95% CI 2.1-5.2), as well as surgeon specialty of otolaryngology compared to general surgery (OR 12.8, 95% CI 4.8-40.8) and procedure sub-type (O-CPM: OR 0.03, 95% CI 0.002-0.16). In multivariate LR, the following variables were significantly associated with XRP use: hospital stay (OR 1.7; 95% CI 1.1-3.0), otolaryngology (OR 105; 95% CI 15.4-2193), O-CPM (OR 0.03; 95% CI 0.002-0.16), and E-CPM (OR 0.04, 95% CI 0.002-0.60)., Conclusions: Prospective, multi-institutional studies are needed to confirm the low clinical utility we observed of early, postoperative XRP following hypopharyngeal surgery for dysphagia., Level of Evidence: 3 Laryngoscope, 132:272-277, 2022., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Hypopharyngeal collapse (HC) considered a challenge in surgery of obstructive sleep apnea (OSA). Several procedures were presented to deal with HC indirectly via providing support to the lateral walls of the hypopharynx preventing transverse collapse but hyoidthryoidpexy had gained more popularity. The procedure aimed to fix the mobile hyoid bone to a rigid mid-line neck structure, thus preventing the bone and its attached muscles from collapsing during sleep with the negative intrathoracic pressure on inspiration., Study Design: A prospective case series study., Methods: From April 2018 to January 2020, A Modified Technique of Trans hyoid hyoidthyroidpexy was applied for all included patients (24) patients with symptoms of OSA showing predominant lateral wall collapse of the hypopharynx (with retro-palatal collapse) with other OSA surgery., Results: 6-8 months postoperatively, the Apnea Hypopnea index dropped from 43.75 ± 8.44 to 16.28 ± 7.35 (P < 0.0001; t = 10.6988). 14 patients (58.33%) were reported as successful while 7 patients (29.17%) were considered responders and three patients (12.5%) were considered non responders. The mean lowest oxygen desaturation elevated from 77.56 ± 5.64 to 92.38 ± 6.25 (p < 0.0001). Epworth Sleepiness Scale improved (P < 0.0001) from 16.85 ± 4.23 to 5.17 ± 3.89., Conclusion: Trans-hyoid hyoidthyroidpwxy is a modified technique of hyoidthyroidpexy. The procedure reported good outcomes in treating OSA. It is a simple, cost-effective and less traumatic technique. It could be combined with other multilevel surgical procedures., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Observing the entire circumference of the hypopharynx is usually difficult because most of the area is anatomically closed in the resting state. The modified Killian's method, consisting of a combination of the modified Killian position, head torsion, and the Valsalva maneuver, is a recently proposed procedure to improve the endoscopic view of the hypopharynx. A fish bone, which was invisible under regular endoscopy but was identified by CT, was successfully observed and removed under the modified Killian's method in a 71-year-old female. This method can be applied to diagnose and treat benign hypopharyngeal disease such as fish bone foreign body in addition to the detection of cancer., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier B.V.)

Background: Hypopharyngeal cancer is associated with poor survival. Robotic surgery is emerging as a treatment for hypopharyngeal tumors, but no rigorous data are available to assess its effect on survival., Methods: The National Cancer Database (NCDB) was used to identify patients with T1 and T2 hypopharyngeal tumors undergoing robotic surgery, laser surgery, and primary radiation with or without chemotherapy from 2010 to 2016. All adult patients with available staging and no distant metastasis were included., Results: We compared 57 patients undergoing robotic surgery, 236 undergoing laser surgery, and 5,742 undergoing primary radiation. Compared to laser surgery, patients undergoing robotic surgery were significantly more likely to have negative margins, neck dissection, lower incomes, and care at an academic center. Rates of robotic surgery also significantly increased from 2010 to 2015. After multivariate regression, robotic surgery was associated with significantly improved overall survival compared to laser surgery and primary radiation., Conclusion: Robotic surgery improves overall survival for T1 and T2 hypopharyngeal tumors compared to laser surgery and primary radiation in this NCDB cohort. This effect may be mediated by decreased positive margin rates relative to laser surgery. Rates of hypopharyngeal robotic surgery are expected to increase with wider adoption of robotic platforms and may improve overall survival rates for hypopharyngeal cancer., (Published by Elsevier Ltd.)

Three types of reconstruction are possible following total laryngopharyngectomy (TLP) for advanced hypopharyngeal cancer: locoregional tubularized island flaps, gastric pull-up and free flaps. Gastro-omental free flap (GOFF) is rarely used in this setting. However, because of its composite nature, this flap has the advantage of being able to restore digestive continuity and reconstruct part of the skin of the neck when it needs to be sacrificed because of tumour invasion or poor trophicity. The GOFF is a reliable and robust flap particularly indicated in hostile environments: repeated neck surgery, atrophic and devascularized skin after radiotherapy, sepsis in the context of fistula and/or pharyngostomy. It requires the collaboration of two or even three surgical teams. In this article, we describe the flap harvesting technique and the complications and functional outcome., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)