Definition & Overview
Pharyngostomy is the surgical process of creating a hole or opening in the throat or neck to insert a pharyngostomy tube. Also known as cervical pharyngostomy, the procedure is done to facilitate feeding when patients can't eat by mouth for a short period. It can also be used to help patients who are having breathing difficulty, as a means of placing an endotracheal tube to open or remove blockages in the airway.
There are many ways of inserting a tube for patients who, for some reasons, can’t eat by mouth. One method is the insertion of a nasogastric tube, in which a narrow tube is inserted into the nasal cavity and then into the stomach. Another method is called percutaneous endoscopic gastrostomy, which inserts a tube directly into the abdominal wall. When these methods are not applicable for any reason or due to patient preference, pharyngostomy is performed.
Pharyngostomy has been practiced since the 1950s and has been refined in the succeeding decades. Some patients prefer this procedure over other methods mentioned above because they do not want to deal with the inconvenience of having a tube inserted into their nasal cavity. Patients with diseases of the stomach may not also be able to tolerate a tube inserted through the abdominal wall.
Who Should Undergo and Expected Results
Pharyngostomy can be recommended for patients suffering from gastric aspiration, or when the contents of the stomach travel back up into the respiratory tract. The patient could aspirate solid food that could travel into the airway and the lungs and cause damages. Gastric acid could also travel back up and cause chemical pneumonitis. Gastric aspiration could also result from treatment procedures or after the patient has undergone anastomosis in the gastrointestinal region.
This procedure is also done on patients who are unable to ingest food for a long period. Such is the case of comatose patients and those diagnosed with persistent dysphagia. This condition is associated with difficulty in swallowing liquid and solid food. It is typically associated with certain neurological and physical conditions. It is quite painful and in extreme cases, the patient may even lose the capability to swallow.
The procedure can also be recommended for patients who have cancers in the oral cavity, pharynx, or larynx as well as those who underwent surgery or radiation therapy for such conditions as they may find it hard to pass food from the mouth to the stomach. Inserting a feeding tube into the side of the neck could help patients get the nutrition they need while waiting for their condition to get better.
Those who have lesions or wounds inside their mouth and pharynx could also be offered pharyngostomy for a short period. This is to avoid unnecessary pain while waiting for their wounds to heal and tissues to regain normal function.
Compared to other means of inserting feeding tube, pharyngostomy is considered safer and more efficient. With this procedure, patients do not have to deal with tubes sticking out of their nose or with a tube in their stomach. This translates to good patient satisfaction rate since they can cover the tube in their neck with turtleneck-type clothing. The placement of pharyngostomy tube also carries less long-term complications compared to the placement of nasogastric tube and gastrostomy.
Because feeding and intake of fluid are done through the pharyngostomy tube, the patient should expect to be placed on a soft or fluid diet for a certain period. They are advised to avoid any strenuous physical activity and should take a lot of rest.
How is the Procedure Performed?
Depending on the need, the patient is placed either under local or general anaesthesia. The surgical site is cleansed and made sterile. The surgeon then locates the pyriform sinus inside the mouth, just beneath the hyoid bone. A pair of forceps is guided and pushed to the wall of the neck. Once the surgeon can feel the tips of the forceps, an incision is made inside the oral cavity until the forceps are seen on the skin surface. One end of the tube is grasped using forceps and guided inside the neck. It is slowly passed through the oesophagus and into the stomach. In most cases, the surgeon uses a laryngoscope to provide visual images inside the pharynx. The tube is also pulled back a little to avoid curling.
If the procedure is done to treat gastric aspiration, any fluid and solid food stuck in the area are taken out first. Feeding can then commence based on the recommended schedule. Those who need to undergo pharyngostomy for an extended period have to go back to their physician’s office to have their tubes replaced regularly, typically once every ten days. During maintenance, a low suction drainage is connected to the tube to remove any obstruction.
If the tube has to be removed, a single suture is used to close the incision.
Possible Risks and Complications
There is the risk of bleeding during and after surgery. The walls of the pharynx might be injured and cause damage to nearby blood vessels. In some rare cases, the arteries near the surgical site could also be injured.
The cells and tissues around the tube can also get irritated by the presence of a foreign body. This might cause inflammation and could result in an infection if not addressed correctly.
There is also the possibility of the tube falling off when the patient moves. In some cases, lesions and abscess can develop after the removal of the pharyngostomy tube. This would necessitate drainage to clear the wound. The procedure can also potentially affect the airways and lungs. A small number of patients can develop respiratory problems and even pneumonia following the procedure.
- Natasha M. Rueth, Natasha Lee, Shawn S. Groth, Sarah C. Stranberg, Michael A. Maddaus, Jonathan D'Cunha, Rafael S. Andrade Pharyngostomy tubes for gastric conduit decompression