[Usefulness and limitation of crico-pharyngeal myotomy and laryngeal suspension after wide resection of the tongue or oropharynx]
Fujimoto Y. Hasegawa Y. Nakayama B. Matsuura H.
Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya.
To prevent post-surgical dysphagia in oral or oropharyngeal cancer patients, crico-pharyngeal myotomy and laryngeal suspension are recommended; however, its indication has been controversial. When it was though that patients would lose the mechanisms of laryngeal elevation or mechanisms to produce oropharyngeal pressure we opted for crico-pharyngeal myotomy and laryngeal suspension: total or subtotal glossectomy with bilateral resection of suprahyoid muscles, and wide resection of the oropharynx including the tongue base. In this paper, we report the usefulness and limitation of crico-pharyngeal myotomy and laryngeal suspension after wide resection of the tongue or oropharynx. PATIENTS AND METHODS: From April 1992 to January 1996, 19 patients received circo-pharyngeal myotomys and laryngeal suspensions along with their initial operation for oral or oropharyngeal cancer. Their ages ranged from 28 to 69 years. Fourteen had tongue cancer and 5 had oropharyngeal cancer. We examined the relationship between the ability to have an oral diet and the extent of mobile tongue resection, extent of tongue base resection, and extent of resection of the lateral wall of the oropharynx, reconstruction method, and age. RESULTS: Fifteen of the 19 patients (68%) could have an oral diet when they were discharged. The extent of tongue base resection (more than 50%) and age (> or = 60) significantly affected post-surgical aspiration. Two patients who had total glossectomy with total tongue base resection could have an oral diet. They were 41 and 51 years old. One 35-year-old patient who had total glossectomy with wide tongue base resection (80%) was able to have the same diet as his family. On the other hand, 4 elderly patients (> or = 60) who had wide resection of the tongue base (> or = 50%) could not have an oral diet at all. CONCLUSION: A crico-pharyngeal myotomy and a laryngeal suspension can contribute to the prevention of post-surgical dysphagia. However, if an elderly patient (> or = 60) has had wide tongue base resection (> = 50%), he may not be able to have an oral diet. In these cases, we have to opt for additional methods, such as total laryngectomy, to prevent aspiration.