التعريف والنظرة العامة
A pharyngolaryngectomy with radical neck dissection is a medical procedure that removes the pharynx and the larynx. The pharynx is the area at the back of the mouth and throat, while the larynx is the voice box. This is a serious procedure that is sometimes performed in two stages, with the second stage focusing on reconstruction. This is to make sure the structures in the throat and neck are able to function properly. The reconstruction procedure may require extensive grafting.
The procedure requires extensive preparation and care to prevent complications. Despite this, the surgery can still have serious and lasting effects on the life of the patient.
من يجب أن يخضع للنتائج المتوقعة
A pharyngolaryngectomy is performed on patients who suffer from malignant tumours or cancerous tissue in the larynx and pharynx. In the majority of cases, the tumours grow on the larynx and eventually spread into the pharynx. The goal of the procedure is to remove the tumour.
In addition, the procedure is also performed on patients who suffered severe damage to the larynx and pharynx, either due to disease or traumatic injury.
In both cases, the procedure is usually performed as a last resort in an attempt to save the patient’s life. It is only used when all other possible methods of treatment have either failed or are inappropriate.
كيف يتم إجراء العملية؟
A pharyngolaryngectomy is a radical, inpatient procedure that requires patients to stay at the hospital for several weeks after the operation. It also requires general anaesthesia.
Due to the severity of circumstances surrounding the procedure, patients are usually admitted to the hospital several days before the scheduled surgery date. Patients undergo a thorough medical examination wherein their vital organs, such as the heart and lungs, are carefully evaluated. Blood tests are also performed to check for anaemia or electrolyte imbalances, which may then prompt a blood or intravenous electrolyte transfusion.
On the day of the procedure, the patient will not be allowed any food or drink after midnight. The areas that will be affected during surgery, such as the neck and the donor area (in case a graft becomes necessary), are shaved and washed with antiseptic. The patient will then be placed under general anaesthesia.
The procedure is then performed through the following steps:
- The patient will be asked to lie down on his back with his neck extended and the head turned to one side.
- The surgeon will make two curved incisions behind the ear going to the chin and at the bottom of the neck.
- Another incision below the second incision will then be made. This will create a hole (stoma) through which the patient will breathe during and after the procedure.
- A laryngectomy tube is inserted, and the larynx is first removed.
- After the larynx is removed, the surgeon cuts out parts of the pharynx that have become affected by the tumour. If the damage to the pharynx is severe, it is also removed completely.
The procedure is followed by a reconstruction surgery, which is usually performed three weeks after the initial surgery. During the reconstruction stage of the procedure, the doctor follows the steps below:
- The surgeon will first take a tissue graft either from the chest, back, thigh, and forearm. The tissue includes blood supply and muscle support.
- Another skin graft is taken from the thigh to repair the area where the original tissue graft was taken.
- The original tissue graft is then used to repair the trachea and the oesophagus.
The circumstances surrounding each pharyngolaryngectomy procedure may differ. This is why surgeons sometimes perform a less invasive version or a partial pharyngolaryngectomy. Sometimes, however, they perform a more radical version of the procedure wherein the thyroid gland, parathyroid gland, and part of the oesophagus are also removed.
After the procedure, the surgeon places a laryngectomy tube in the patient’s stoma. This prevents the stoma from narrowing. In addition, it also allows the patient to breathe through the stoma despite wound dressings that are placed on top of the incision sites.
The recovery process following a pharyngolaryngectomy can be difficult. Patients are not allowed to swallow for several days. Thus, their saliva is sucked out of their mouths. It may take about a week before the patients can swallow normally again. Once this happens, the patient can resume eating through the mouth. This transition period is closely monitored to make sure no food leaks from the pharynx into the neck.
Patients will no longer be able to cough as well, so they cannot clear their lungs. Thus, mucus and sputum have to be sucked out as well from the laryngectomy tube. Drain tubes are also placed and left in place for about three days or until the wound discharge stops.
Patients are also given an electric signboard so they can communicate. They can begin speech therapy once they have recovered from the final stage of the procedure.
المخاطر والمضاعفات المحتملة
As a radical procedure, patients who undergo a pharyngolaryngectomy can expect some major changes in their lives after the procedure. These include:
- Permanently breathing through a hole in the neck
- Possible permanent voice loss
Due to these permanent effects, patients go through extensive counselling before and after undergoing the procedure. Patients also undergo speech therapy after the procedure to try and recover a certain amount of vocalisation. Nevertheless, the procedure is traumatic for patients and their families, and may greatly affect their quality of life. Patients are thus also encouraged to communicate with a pharyngolaryngectomy organisation or support group.
Aside from these permanent effects, patients also face the usual risks associated with major surgery. These include bleeding, infection, and allergic reaction to anaesthesia. Thus, patients are given pain medications and antibiotics while they are recovering.
Other potential complications include:
- Wound breakdown, which can be caused by undue stress on the pharynx or neck during the recovery period
- Leakage into the neck tissues
- Graft incompatibility
- ورم دموي
Some of these complications may require more surgery.
Anand VK. “Pharyngolaryngectomy.” Nose and Sinus Clinic. http://www.noseandsinus.net/sites/default/files/Pharyngolaryngectomy_PT-INFO.pdf
Karri V, Yang MC, Chung KP, Chen SH, Mardini S, Chen HC. “Total pharyngolarynectomy and voice reconstruction with ileocolon free flap: Functional outcome and quality of life.” Journal of Plastic, Reconstructive & Aesthetic Surgery. 2011 July. 64(7): 911-920. http://www.sciencedirect.com/science/article/pii/S1748681510006881
**Meta Title**: Pharyngolaryngectomy with Radical Neck Dissection: An Overview, Benefits, and Expected Results
**Meta Description**: Discover the comprehensive details of pharyngolaryngectomy with radical neck dissection, including its benefits, expected results, and possible reconstruction procedures. Explore this surgical option and its potential impact on patients’ lives.
**H1**: Pharyngolaryngectomy with Radical Neck Dissection: Overview, Benefits, and Expected Results
Pharyngolaryngectomy with radical neck dissection is a surgical procedure performed to treat advanced cases of pharyngeal and laryngeal cancers. It involves the complete removal of the pharynx, larynx, and surrounding lymph nodes in the neck while aiming for complete tumor removal. This surgery may also incorporate reconstruction techniques to restore function, appearance, and quality of life for patients. In this article, we will explore the overview, benefits, and expected results of pharyngolaryngectomy with radical neck dissection, providing valuable information for patients and their loved ones.
**H2**: Overview of Pharyngolaryngectomy with Radical Neck Dissection
Pharyngolaryngectomy with radical neck dissection is primarily recommended for individuals dealing with advanced tumors in the pharynx or larynx that may not respond well to other treatment options. This surgery aims to remove the cancerous tissues while striving to preserve surrounding structures and maintain optimal functional outcomes. Here are some key points to consider:
1. **Indications for Pharyngolaryngectomy with Radical Neck Dissection**: This procedure is typically considered when other treatment options, such as radiation therapy or chemotherapy, have been ineffective or are contraindicated. The decision to undergo this surgery will be based on the individual’s specific circumstances, such as the stage of the cancer, its location, and the overall health of the patient.
2. **Surgical Approach**: Pharyngolaryngectomy with radical neck dissection is performed under general anesthesia. The surgeon accesses the tumor through an incision in the neck, removing the affected pharyngeal and laryngeal structures, as well as the surrounding lymph nodes. In some cases, reconstruction procedures may also be performed to restore form and function.
3. **Potential Reconstruction Options**: The reconstruction phase of the surgery aims to restore the swallowing function and maintain a satisfactory airway passage. Several techniques can be utilized, including primary closure, regional flaps, or free tissue transfer. These procedures are tailored to each patient’s needs and can significantly improve their quality of life after surgery.
**H2**: Benefits of Pharyngolaryngectomy with Radical Neck Dissection
Undergoing pharyngolaryngectomy with radical neck dissection presents several benefits for patients dealing with advanced pharyngeal and laryngeal cancers. These benefits include:
1. **Tumor Clearance**: By removing the affected tissues and lymph nodes, this surgery offers the possibility of a complete tumor clearance. This can lead to improved outcomes and a reduced risk of cancer recurrence.
2. **Improved Long-Term Survival**: Pharyngolaryngectomy with radical neck dissection has shown promising results in increasing long-term survival rates for patients with advanced cancer. While the individual’s overall health and cancer stage are important factors, this surgery offers a potential cure or prolonged disease control.
3. **Enhanced Quality of Life**: Although this surgery involves the removal of important structures, reconstruction techniques aim to restore function and aesthetics. Through the restoration of vital functions such as swallowing and speaking, patients can experience an improved quality of life.
4. **Personalized Approach**: Each surgery is tailored to the patient’s specific needs, allowing the surgical team to address individual concerns and requirements. This personalized approach ensures optimal outcomes for patients while considering their unique circumstances.
**H2**: Expected Results and Recovery Process
Following pharyngolaryngectomy with radical neck dissection, patients can expect certain outcomes during the post-operative and recovery phases. These outcomes may vary depending on the specifics of the surgery and the patient’s overall health. Here are some expected results and the recovery process:
1. **Initial Hospital Stay**: Patients undergoing this surgery typically stay in the hospital for several days to monitor their condition, manage pain, and promote healing. During this time, healthcare professionals will assist with activities such as nutrition, speech therapy, and wound care.
2. **Swallowing Rehabilitation**: Restoration of swallowing function is a key aspect of recovery. An interdisciplinary team, including speech-language pathologists and dietitians, will work closely with patients to facilitate their swallowing rehabilitation. Eating modifications and exercises may be necessary to enhance their ability to swallow safely.
3. **Speech and Communication**: As the larynx is removed during this surgery, patients will experience changes in their ability to speak. Speech-language pathologists will play a crucial role in helping patients explore alternative communication methods, such as tracheoesophageal puncture (TEP) and voice prostheses. Extensive speech therapy will be provided to adapt to these changes effectively.
4. **Follow-Up Care**: Regular follow-up appointments will be scheduled to monitor healing, assess functional outcomes, and address any concerns or complications. These visits will help guide patients on their journey to recovery, providing necessary support and guidance throughout the post-operative period.
To summarize, pharyngolaryngectomy with radical neck dissection is a surgical procedure that offers hope for individuals battling advanced pharyngeal and laryngeal cancers. By removing cancerous tissues and nearby lymph nodes, this surgery aims to eradicate the disease and improve long-term survival rates. Reconstruction procedures can enhance functional outcomes and restore quality of life. Although this surgery requires significant recovery, a multidisciplinary team of healthcare professionals will provide guidance and support throughout the rehabilitation process. For individuals facing this procedure, understanding its overview, benefits, and expected results can help alleviate concerns and guide them towards a successful recovery.