In this extremely important chapter, the introduction includes relevant surgical anatomy, physiology and functional correlates.
Pharyngeal defects are broadly classified as those with an intact larynx, and those in which total laryngectomy has been performed.
In the former (smaller) group, demonstrated cases show demonstrate approaches to small oropharyngeal defects, and to reconstruction following radical resections for primary advanced staged cancers of the vallecula, with preservation of phonation via a horizontal supraglottic laryngectomy. In all cases with an intact larynx, the most significant consideration is prevention of aspiration and restoration of adequate swallowing.
In patients who need total laryngectomy, there are essentially three types of defects: those that can be closed primarily, those that need some tissue to create a normal sized pharynx (augmentation pharyngoplasty) and those that need circumferential reconstruction.
A detailed treatment of all three types of defects is presented with illustrative cases as well as details for primary speech rehabilitation with a TEP with voice prosthesis.
In patients where the defect extends below the thoracic inlet, Gastric transposition is the only alternative.