Hypopharyngeal pharyngoplasty in the management of pharyngeal paralysis: A new procedure

Dysphagia after a high vagal nerve injury may be associated with a patulous hypopharynx that serves as a reservoir for pharyngeal secretions, contributing to primary or secondary aspiration. We describe a new hypopharyngeal pharyngoplasty procedure for the paralyzed pharynx to improve swallow. The paralyzed pyriform sinus is resected to remove insensate and redundant mucosa. The inferior constrictor muscle is then advanced anterior to the oblique line of the thyroid cartilage to improve pharyngeal tone and prevent pharyngeal dilatation. The surgery is performed in conjunction with medialization laryngoplasty and arytenoid adduction. The utility of this procedure is reviewed retrospectively in 8 patients. They were evaluated by clinical evaluation, fiberoptic endoscopic evaluation of swallow, and modified barium swallow study. All had significant preoperative dysphagia. Three patients were gastrostomy tube-dependent. After operation, all patients had subjective and objective improvements in swallow and progressed to peroral feeding. There were no operative complications. We conclude that hypopharyngeal pharyngoplasty diminishes pyriform sinus pooling and improves pharyngeal transit. Dysphagia patients with unilateral pharyngeal paralysis secondary to cranial nerve palsies may benefit from this new procedure.