Laryngeal Function Preservation Surgery in Pyriform Sinus Cancer

In some cases of pyriform sinus cancer, it is possible to preserve laryngeal function by partial laryngopharyngectomy. We reported a case of right pyriform sinus cancer involving the aryepiglottic fold, for which hemicricolaryngopharyngectomy and laryngeal reconstruction with an auriclar graft were performed.The hemilarynx, ipsilateral pyriform sinus, and half of the cricoid ring were resected according to the method of hemicricolaryngopharyngectomy reported by Krespi and Sisson. The pharynx was reconstructed primarily by suturing. At first, we tried to reconstruct the larynx with a free retroauricular chondrocutaneous flap. However, because of a vasospasm, we had to give up a primary laryngeal reconstruction. Therefore, the remaining larynx was kept open as a laryngocutaneous fistula, and a retroauricular chondrocutaneous flap was grafted onto the left forearm to make a prefabricated flap for the preparation of secondary reconstruction of the larynx. In addition, a laryngeal suspension to the hyoid bone and cricopharyngeal myotomy were carried out to avoid postoperative aspiration.In the second stage of the operation, the left forearm flap with the auricle was grafted onto the larynx to reconstruct the laryngeal framework and glottis. A bulging part of the autihelix was sutured at the same level with the remaining vocal fold to obtain sufficient glottal closure.Four weeks after the second operation, the tracheostoma could be closed. Dyspnea was not seen and phonation was good. Although slight aspiration occurred when drinking liquid quickly, laryngeal functions was satisfactory. Two courses of postoperative anticancer chemotherapy were administrated, and the patient remained free from tumor for about eleven months after the resection.