Posterior pharyngeal carcinoma resection with larynx preservation and radial forearm free flap reconstruction: A preliminary report

Background: Surgical management of selected posterior pharyngeal wall lesions can be performed with pharyngectomy, allowing for larynx preservation, with radial forearm free flap (RFFF) reconstruction. Methods: Retrospective review of our experience using RFFF reconstruction in 9 patients. Results: All 9 patients had a posterior pharyngectomy with larynx preservation, neck dissection (3 bilateral, 6 unilateral), and RFFF reconstruction. Six patients experienced 8 postoperative complications including one postoperative death. Only 3 patients were able to obtain all nutrition orally. Tracheotomy decannulation occurred in 4 patients and voice was maintained in all patients, American Society of Anesthesiologists score (ASA) was an accurate predictor of postoperative medical complications. Conclusions: Posterior pharyngeal resections with larynx preservation and RFFF reconstruction can be accomplished with acceptable morbidity in healthy patients with carefully selected lesions of the posterior pharyngeal wall. However, in patients with significant co-morbidities as reflected by an ASA of 3 or more, larynx preservation and RPFF reconstruction was fraught with significant morbidity and is not recommended.