QUAD #5 Pharyngeal Scar Management with Dr. Doug von Allmen

In pharyngeal stenosis related to caustic ingestion, clinicians must address not only physical obstruction but also altered sensation and altered motor function

The presented patient had extensive scarring in the hypopharynx with no discernible esophageal inlet and no discernible laryngeal structures, with base of tongue scarred to hypopharyngeal wall

After scar tissue removal, the large raw surface area poses a risk of re-scarring

Some surgeons have used free mucosal grafts to prevent re-scarring after scar tissue removal

A modified suprastomal stent can be placed through the glottis and secured with suture, then wrapped with silastic sheeting to increase the stent diameter in the pharynx

Patients with caustic injuries sometimes tolerate suprastomal stents better than airway reconstruction patients because disrupted sensation in the hypopharynx and oropharynx reduces gagging and retching

At one-year follow-up, the presented patient maintained a fairly decent opening to the glottis but remains tracheostomy and G-tube dependent

The patient underwent colon interposition and was able to get PO taste with improved secretion management, but continues to have swallowing dysfunction

In the oropharynx and hypopharynx, a larger caliber balloon is needed for dilation

Rotational flaps and free flaps can be used to help break up scarring in pharyngeal stenosis

Z-plasty technique can be used to break up scar orientation by rotating mucosal flaps

Staged procedures are helpful to avoid creating circumferential scarring again

Many pharyngeal stenosis patients require tracheostomy, often due to extensive supraglottic scarring

Involvement of speech language pathologists and pulmonary colleagues is important to help manage the sequelae of aspiration

Pharyngeal stenosis patients warrant long-term surveillance as there is suggestion they may be at increased risk for malignancy, and surveillance for neoplasm development is helpful