Definition & Overview
A pharyngolaryngectomy with radical neck dissection is a medical procedure that removes the pharynx and the larynx. The pharynx is the area at the back of the mouth and throat, while the larynx is the voice box. This is a serious procedure that is sometimes performed in two stages, with the second stage focusing on reconstruction. This is to make sure the structures in the throat and neck are able to function properly. The reconstruction procedure may require extensive grafting.
The procedure requires extensive preparation and care to prevent complications. Despite this, the surgery can still have serious and lasting effects on the life of the patient.
Who Should Undergo and Expected Results
A pharyngolaryngectomy is performed on patients who suffer from malignant tumours or cancerous tissue in the larynx and pharynx. In the majority of cases, the tumours grow on the larynx and eventually spread into the pharynx. The goal of the procedure is to remove the tumour.
In addition, the procedure is also performed on patients who suffered severe damage to the larynx and pharynx, either due to disease or traumatic injury.
In both cases, the procedure is usually performed as a last resort in an attempt to save the patient’s life. It is only used when all other possible methods of treatment have either failed or are inappropriate.
How is the Procedure Performed?
A pharyngolaryngectomy is a radical, inpatient procedure that requires patients to stay at the hospital for several weeks after the operation. It also requires general anaesthesia.
Due to the severity of circumstances surrounding the procedure, patients are usually admitted to the hospital several days before the scheduled surgery date. Patients undergo a thorough medical examination wherein their vital organs, such as the heart and lungs, are carefully evaluated. Blood tests are also performed to check for anaemia or electrolyte imbalances, which may then prompt a blood or intravenous electrolyte transfusion.
On the day of the procedure, the patient will not be allowed any food or drink after midnight. The areas that will be affected during surgery, such as the neck and the donor area (in case a graft becomes necessary), are shaved and washed with antiseptic. The patient will then be placed under general anaesthesia.
The procedure is then performed through the following steps:
- The patient will be asked to lie down on his back with his neck extended and the head turned to one side.
- The surgeon will make two curved incisions behind the ear going to the chin and at the bottom of the neck.
- Another incision below the second incision will then be made. This will create a hole (stoma) through which the patient will breathe during and after the procedure.
- A laryngectomy tube is inserted, and the larynx is first removed.
- After the larynx is removed, the surgeon cuts out parts of the pharynx that have become affected by the tumour. If the damage to the pharynx is severe, it is also removed completely.
The procedure is followed by a reconstruction surgery, which is usually performed three weeks after the initial surgery. During the reconstruction stage of the procedure, the doctor follows the steps below:
- The surgeon will first take a tissue graft either from the chest, back, thigh, and forearm. The tissue includes blood supply and muscle support.
- Another skin graft is taken from the thigh to repair the area where the original tissue graft was taken.
- The original tissue graft is then used to repair the trachea and the oesophagus.
The circumstances surrounding each pharyngolaryngectomy procedure may differ. This is why surgeons sometimes perform a less invasive version or a partial pharyngolaryngectomy. Sometimes, however, they perform a more radical version of the procedure wherein the thyroid gland, parathyroid gland, and part of the oesophagus are also removed.
After the procedure, the surgeon places a laryngectomy tube in the patient’s stoma. This prevents the stoma from narrowing. In addition, it also allows the patient to breathe through the stoma despite wound dressings that are placed on top of the incision sites.
The recovery process following a pharyngolaryngectomy can be difficult. Patients are not allowed to swallow for several days. Thus, their saliva is sucked out of their mouths. It may take about a week before the patients can swallow normally again. Once this happens, the patient can resume eating through the mouth. This transition period is closely monitored to make sure no food leaks from the pharynx into the neck.
Patients will no longer be able to cough as well, so they cannot clear their lungs. Thus, mucus and sputum have to be sucked out as well from the laryngectomy tube. Drain tubes are also placed and left in place for about three days or until the wound discharge stops.
Patients are also given an electric signboard so they can communicate. They can begin speech therapy once they have recovered from the final stage of the procedure.
Possible Risks and Complications
As a radical procedure, patients who undergo a pharyngolaryngectomy can expect some major changes in their lives after the procedure. These include:
- Permanently breathing through a hole in the neck
- Possible permanent voice loss
Due to these permanent effects, patients go through extensive counselling before and after undergoing the procedure. Patients also undergo speech therapy after the procedure to try and recover a certain amount of vocalisation. Nevertheless, the procedure is traumatic for patients and their families, and may greatly affect their quality of life. Patients are thus also encouraged to communicate with a pharyngolaryngectomy organisation or support group.
Aside from these permanent effects, patients also face the usual risks associated with major surgery. These include bleeding, infection, and allergic reaction to anaesthesia. Thus, patients are given pain medications and antibiotics while they are recovering.
Other potential complications include:
- Wound breakdown, which can be caused by undue stress on the pharynx or neck during the recovery period
- Leakage into the neck tissues
- Graft incompatibility
Some of these complications may require more surgery.
Anand VK. “Pharyngolaryngectomy.” Nose and Sinus Clinic. http://www.noseandsinus.net/sites/default/files/Pharyngolaryngectomy_PT-INFO.pdf
Karri V, Yang MC, Chung KP, Chen SH, Mardini S, Chen HC. “Total pharyngolarynectomy and voice reconstruction with ileocolon free flap: Functional outcome and quality of life.” Journal of Plastic, Reconstructive & Aesthetic Surgery. 2011 July. 64(7): 911-920. http://www.sciencedirect.com/science/article/pii/S1748681510006881