The Submental Myocutaneous Flap for Circumferential Neopharyngeal Reconstruction: A Novel Technique

Abstract

Objectives:

1) Describe a novel technique for circumferential neopharyngeal reconstruction utilizing a submental myocutaneous flap following total laryngopharyngectomy. 2) Discuss surgical planning and peri-operative management for reconstruction. 3) Evaluate this technique’s benefit over existing techniques.

Methods:

We describe a patient who underwent total laryngopharyngectomy with immediate neopharyngeal reconstruction using a myocutaneous submental flap. This is the first report of successful repair using this technique in the United States, according to our literature review. We compare this novel method with current techniques for repairing circumferential pharyngectomy defects.

Results:

Total laryngopharyngectomy was required for a recurrent squamous cell carcinoma of the hypopharynx, which involved the left arytenoid, pyriform sinus, and past midline posteriorly. The pharyngeal defect was circumferential measuring 8cm in length. A submental flap 8cm wide by 15cm long was elevated and tubed to form a neopharynx, was sutured longitudinally at one vertical seam, and attached to the superior and inferior borders of the native pharynx. A nasogastric tube remained in place for nine days to serve as a conduit in the newly formed pharyngeal construct. A swallow study did not demonstrate contrast extravasation or fistula. The patient completed adjuvant radiotherapy and is undergoing surveillance monitoring.

Conclusions:

The myocutaneous submental flap is a practical, regional option for immediate neopharyngeal reconstruction after total laryngopharyngectomy. Adequate time for wound healing before initiation of oral feeding is essential to prevent fistula formation. Functional recovery of swallowing is possible with the tubed submental flap and spares the patient morbidity associated with more complex reconstructions.