Definition & Overview
The resection of the lateral pharyngeal wall is a surgical procedure of removing tumours or cancerous growths from the lateral wall of the pharynx. Also known as pharyngotomy, the procedure is often performed to treat carcinoma of the oropharynx and pyriform sinus.
The oropharynx is located right behind the oral cavity or the mouth. It starts from the uvula and ends in the hyoid bone. The lateral wall of the oropharynx is where the palatine tonsils are located. Other parts of the lateral wall are the tonsillar fossa and tonsillar pillars. The whole oropharynx is part of the pharynx that functions as a passageway for food and air.
The pyriform sinuses are a pair of recessed structure found on the sides of the larynx. It is also called the pyriform recess, the pyriform fossa, smuggler’s fossa, or vallecula of the throat. It is also where the internal laryngeal nerve is located.
Who Should Undergo and Expected Results
Patients diagnosed with oropharyngeal cancer, especially those in the lateral pharyngeal wall, are eligible for surgery. This condition typically affects mature adults and occurs more often in men than women. Among its risk factors are a long history of smoking and an infection caused by a particular strain of the human papillomavirus. This condition is characterised by pain in the neck area, weight loss, growth of tissue masses in the neck, and dysphagia or difficulty in swallowing. Most cases of cancer in the oropharynx occur in the tonsils and tonsillar pillar.
The procedure is also recommended for those who are suffering from cancer of the pyriform sinus. The most frequent type of cancer in this particular body part is squamous cell carcinoma. It is a condition that is often asymptomatic in its early stages, making it difficult to be detected right away. However, once diagnosed, it is possible to perform surgery to remove the cancerous cells while preserving the larynx. Its symptoms include recurring sore throat, dysphagia, and the sensation of having food stuck in the throat.
The growth of benign tumours in the lateral wall of the pharynx or in the pyriform sinus is also a good indication for resection. In some cases, large tumours obstruct the passage of food in the pharynx or impede proper speech. Benign lesions in the area may also be removed if there is a possibility that they will become cancerous or if the patient has a family history of cancer.
This procedure has a good success rate especially for those who have early stages of cancer in the lateral wall of the pharynx or pyriform sinus. In most cases, patients also undergo radiation therapy after surgery to eliminate remaining cancer cells. Combination therapy helps improve survival rates among patients.
After surgery, patients are required to rest for several weeks to allow their wounds to heal. They should also avoid strenuous activities. Subsequent visits to their physician are also required to evaluate their progress.
Patients are also placed on a soft diet until the affected tissues are completely healed.
How is the Procedure Performed?
The patient is placed under general anaesthesia for the procedure. There are several approaches that the surgeon can use in resecting the lateral pharyngeal wall and pyriform sinus.
The transoral approach is typically used for small lesions in the pharyngeal wall. A mouth gag is placed in the patient’s mouth to keep it open and expose the pharyngeal wall. The soft palate is then retracted using rubber catheters or stay sutures. Using a scalpel, laser, or an electrocautery probe, the lesion or growth is carefully excised or cut away, along with a margin of healthy cells around it. A variation of this approach involves detaching the oral cavity parts from the mandible. Taking care not to injure the hypoglossal nerve, incisions are made in the area. Another incision is made where the tongue is attached to the mandible. The tongue is then pulled back and the lesions are resected. Once all the lesions have been removed, the surgeon will close the surgical site using sutures.
Some surgeons prefer making the incisions through the neck. Once the structures of the neck are clearly defined, incisions are made to expose the hyoid bone and the upper part of the thyroid cartilage. Using laparoscopy, the surgeon then exposes the tumour cells and excises them. The incisions are closed with sutures. However, in cases when sutures are inadequate for closures, a flap may be necessary. If there is a need, the surgeon will also perform a tracheostomy to create an opening in the neck area to assist in breathing. This also helps in the intake of food among patients who are unable to swallow or pass food from the mouth to the stomach.
If there is a need, the surgeon will also make incisions on the skin where the lymph nodes are located. The nodes are excised and removed to help prevent the spread of cancer to other parts of the body as well as cancer recurrence.
Specimen collected from the lateral pharyngeal wall and the pyriform sinuses are then sent to a pathology laboratory for examination.
Possible Risks and Complications
There is the possibility of excessive bleeding or haemorrhage while performing the procedure. This can be caused by an injury to the blood vessels in the area. The nerve that supports the tongue could also get injured. This can lead to numbness or permanent paralysis. In some cases, the patient’s ability to taste food is also diminished.
Infection could also set in on the surgical site. If left unattended, this could lead to sepsis or infection of the blood. In addition, there is a possibility of recurrence among cancer patients despite the effort of removing all cancer cells from this area.
- Cummings Otolaryngology - Head and Neck Surgery By Paul W. Flint, Bruce H. Haughey, K. Thomas Robbins, J. Regan Thomas, John K. Niparko, Valerie J. Lund, Marci M. Lesperance