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Resumen La cirugia transoral de la orofaringe ha presentado una importante evolucion en los ultimos anos, al ampliarse las opciones quirurgicas disponibles (TORS, TOUSS, TOLS), la capacidad de resecar lesiones cada vez mas extensas y el numero de pacientes que se beneficia de ellas. Este hecho ha provocado una evolucion en la reconstruccion de los defectos quirurgicos tras cirugia transoral. Este articulo tiene como objetivo la revision de las posibles tecnicas reconstructivas, las indicaciones y factores que tener en cuenta previamente a la cirugia, ademas de proponer un protocolo para valorar la necesidad de reconstruccion transoral sobre la base de la profundidad del defecto, la estadificacion y el tratamiento previamente recibido.

Despite good outcomes of COAn observational, prospective, nonrandomized study.One hundred and twenty-eight patients met the inclusion criteria. The total rate of intraoperative complications was 14.8% (19/128). The rate of complications according to anatomical location was 7 (38.8%) of 18 for supraglottic tumors and 11 (10.3%) of 107 for glottic tumors, and 1 (33.3%) of 3 for subglottic tumors (Previous studies reported good oncologic outcomes and low complication rates with CO

Transoral surgery of the oropharynx has seen an important evolution in recent years, expanding the surgical options available (TORS, TOUSS, TOLS). The capacity to resect increasingly extensive lesions and the number of patients who benefit from them. This fact has led to an evolution in the reconstruction of surgical defects after transoral surgery. This article aims to review the possible reconstructive techniques, indications and factors to be taken into account prior to surgery, proposing a protocol to assess the need for transoral reconstruction based on the depth of the defect, the staging, and previous treatment.

Introduction Pharyngocutaneous fistula is the most frequent complication after total laryngectomy. Its incidence varies between 9%–25% in post primary total laryngectomy patients, to 14%–57% in salvage laryngectomy post radiotherapy or post chemotherapy+radiotherapy. The pectoralis major myofascial flap (PMMF) is postulated as a useful tool to decrease the incidence of this complication. Materials and method Retrospective analysis of a group of patients treated by salvage laryngectomy, associated or not with pharyngeal closure reinforcement with PMMF. Results Twenty patients were included, 18 males (90%) and 2 females (10%), in 10 of whom the PMMF was used. The average age was 66.65 years. Seventeen (85%) had a laryngeal tumour and 3 (15%) had a hypopharyngeal tumour. Eight (80%) patients in the non-PMMF group had postoperative fistula, whereas only 2 (20%) patients in the PMMF group had a fistula during the postoperative period (P=.005). The mean time for fistula closure was significantly shorter in the cases where PMMF flap was used (16±11 days vs. 76.8±67 days, P=.001), as was hospital stay (19.6±18 days vs. 83.9±77 days, P=.001). Conclusion The use of PMMF in our series is associated with a lower rate of post salvage laryngectomy fistulas in patients treated primarily by organ preservation protocol for laryngeal/hypopharyngeal cancer. In turn, it promotes local healing by decreasing the mean duration of fistula closure and the mean hospital stay.