Primary closure of pharyngeal remnant after total laryngectomy and partial pharyngectomy: how much residual mucosa is sufficient?

After total laryngectomy with or without partial pharyngectomy, the remaining pharyngeal defect can be repaired either by primary closure or with additional tissue, depending on the amount of pharyngeal tissue remnant available. The aim of this study was to determine the minimum width of the pharyngeal remnant that could be safely closed primarily without causing difficulty in swallowing. A total of 52 consecutive patients who underwent total laryngectomy were entered into the study. The relaxed and stretched widths of the pharyngeal remnant were measured after removal of the specimen. The widths of the pharyngeal mucosa ranged from 1.5 to 5.0 cm relaxed (mean, 3.24 cm) and from 2.5 to 8.0 cm stretched (mean, 4.83 cm). All neopharynx was reconstructed by closing the pharynx primarily. Seven of the 52 patients developed recurrent tumor with concomitant dysphagia. Two of the 45 patients without recurrence presented with acute dysphagia from food bolus obstruction, and 1 patient developed benign inflammatory stricture following an episode of fish-bone impaction. The narrowest widths of the pharyngeal remnant in this group of 45 were 1.5 cm relaxed and 2.5 cm stretched. As these patients do not have swallowing difficulty, we conclude that in the absence of tumor recurrence, this amount of residual pharyngeal tissue is sufficient both for primary closure of the pharynx and in restoring swallowing function.     

Malignant keratoma

INTRODUCTION: Birth of an Harlequin fetus in an African maternity ward is an exceptional event. There is no question as to the diagnosis, but no treatment is available. CASE REPORT: A female infant was delivered with typical lesions of malignant keratoma. Death occurred 20 hours after birth. DISCUSSION: In countries with adequate intensive care facilities (hydration, acitretine), such infants may occasionally survive with the risk of developing major lamellar ichthyosis which remains a handicap for the rest of life. In Burkina-Faso, such therapeutic facilities are lacking as are means of antenatal diagnosis. The ethical question as to whether or not to attempt survival measures is quite different under these conditions.