Combined anterior cervical spine fusion and total laryngopharyngectomy with free flap reconstruction: A technical note

Abstract

Background and importance: In complex cases such as dropped head cervical deformity due to post-radiation myopathy, anterior cervical discectomy and fusion (ACDF) could be done for deformity correction. In rare circumstances where there is a concurrent need for a total laryngopharyngectomy (TLP) and ACDF, there is a remarkable corridor for cervical discectomy and fusion from the extensive neck exposure. Clinical presentation: We present the case of a patient with history of primary oropharyngeal squamous cell carcinoma and left parotid carcinoma status post treatment, now with post-radiation laryngeal dysfunction and dropped head cervical spinal deformity. Patient underwent posterior fixation for deformity correction and also to create anterior access for total laryngopharyngectomy (TLP). He then underwent combined TLP with anterolateral thigh (ALT) free flap reconstruction and C3-5 ACDF with a vascularized pre-vertebral fascia flap coverage of the spinal hardware. Conclusion: This unique case report is the first of its kind where total laryngopharyngectomy with free flap reconstruction was performed together with an anterior cervical discectomy and fusion. Though complex, such procedures can be performed with satisfactory outcomes in well-established centers.

Keywords

• Anterior cervical fusion
• Total Laryngopharyngectomy
• Free flap reconstruction
• Head / neck cancer
• Chin-on-chest deformity