A myomucosal reconstruction solution to stricture postradiation cervical esophagus

Abstract

A late side effect of radiation for head and neck cancer that has a significant effect on quality of life is esophageal stricture. Many newer techniques of radiation have evolved, but esophageal stricture still remains a complication, especially in a concurrent chemoradiation setting. The treatment options in such conditions can be either invasive or noninvasive. We present a reconstructive option in the form of islanded facial artery myomucosal (iFAMM) flap which carries less donor site morbidity and also provides a mucosal lining. A patient with carcinoma hypopharynx reported with dysphagia following concurrent chemoradiation. The patient was evaluated clinically (video-laryngoscopy, esophago-gastro-duodenoscopy, and video-fluoroscopy) and radiologically and diagnosed as stricture cervical esophagus. The patient had undergone repeated noninvasive techniques of dilatation and failed. Stricture release and patch pharyngoplasty were done with iFAMM flap. Till the last follow-up of 1 year, the patient showed satisfactory deglutition with normal voice. iFAMM is a viable and esthetically appealing option for reconstruction of partial postradiation hypopharynx and cervical esophagus stricture of up to 6 cm in length that are not amenable to dilatation procedures.

Keywords

• esophageal stricture
• island flaps
• radiation effects
• surgical flaps
• upper aero-digestive tract neoplasms