Partial laryngectomies: when the problem is the pexy

Abstract

To analyse the complications related to pexy, the main clinical manifestations that may raise suspicions of a pexy line rupture/detachment, the most suitable diagnostic technique and the optimum treatment to resolve this complication. This is a retrospective chart review in tertiary university referral centre. Medical charts of patients with oncological laryngeal pathologies admitted to the Otolaryngology Department of the University Hospital of Modena between May 2003 and March 2012 were analysed. Ten patients with rupture of the pexy were identified and included in the present study. The clinical manifestations were dysphagia, alteration of sensitivity of hypopharyngeallaryngeal structures, fever, infection and diastasis of surgical wounds, bleeding, dysphonia and aspiration pneumonia. Rupture of the pexy was diagnosed through endoscopic evaluations, radiological techniques or directly in the operating room during revision surgery of the earlier operation. Surgical treatments, coupled with effective swallowing rehabilitation, allowed progressive functional recovery. Patients were hospitalised until recovery of laryngeal functions was complete. In conclusion, pexy line rupture is one of the complications in the post-operative period of partial laryngectomies. Certain clinical manifestations may indicate this complication, helping the surgeon to establish an early diagnosis and administer prompt treatment.

Keywords: Dysphagia; Dyspnoea; Laryngeal cancer; Partial laryngectomies; Pexy.

Fig. 1.

A post-operative latero-lateral neck X-ray in a patient who underwent partial reconstructive laryngectomy: the detachment of the pexy is visible as an air band between the hyoid bone (above) and the cricoid cartilage (below).

Fig. 2.

A 3D neck CT scan shows the gap between the hyoid bone (above) and the cricoid cartilage (below) in a patient with detachment of the pexy who underwent partial reconstructive laryngectomy.