Possible Cause and Counterplan for Stenosis in Cervical Esophagus Reconstructed with Pectoralis Major Myocutaneous Flap

In the past three years, thirty-nine patients with hypopharyngeal cancer were treated in Keio University Hospital by total laryngopharyngectomy and primary reconstruction with pectoralis major myocutaneous flap.These thirty-nine patients were examined on their swallowing function by esophagography and flexible fiberscopy.In seven patients complaining various degree of dysphagia showed stenosis at mucocutaneous junctions, six at the junction to the esophagus and only one to the pharynx. Most of these stenoses were found in the patients who showed salivary fistula that were observed most likely in the patients who had a history of previous radiotherapy with more than 6000 rads.We conclude that salivary fistula is the cause of these stenoses and some devices in operative technique should be developed in order to prevent salivary fistula.