CaseReport
Use of Supraclavicular Flap by End to Side Technique in
Pharyngeal SCC: A Case Report and Review of Literature
Aslan Ahmadi ,
1,2
Ayda Sanaei ,
1,2
Delaram Jan ,
1,2
and Maryam Zolfaghary
1,2
1
ENTandHead&NeckResearchCenter,eFiveSensesInstitute,IranUniversityofMedicalScience,Tehran,Iran
2
ENTandHead&NeckResearchCenterandDepartment,FiveSensesHealthResearchInstitute,HazratRasoulAkramHospital,
Tehran,Iran
Correspondence should be addressed to Ayda Sanaei; sanaie_aida@yahoo.com
Received 6 November 2020; Revised 19 March 2021; Accepted 9 July 2021; Published 15 July 2021
Academic Editor: Richard T. Miyamoto
Copyright©2021AslanAhmadietal.isisanopenaccessarticledistributedundertheCreativeCommonsAttributionLicense,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objectives. In recent years, conservation laryngeal surgeries, including partial pharyngectomy, have been introduced as an al-
ternative procedure for selected cases of hypopharyngeal squamous cell carcinoma (HSCC). Reconstruction of these defects
presents a considerable challenge for the surgeon after partial pharyngectomy due to its circumferential nature. In this case report,
we represent the innovative “End to side” technique to reconstruct hypopharyngeal defect using the rolled supraclavicular flap
after laryngeal-preserving partial pharyngectomy. Methods and Results. A 70-year-old female presented with a history of
progressive dysphagia and odynophagia. e evaluations revealed a T3N0M0 SCC of pyriform sinus. e mass was successfully
resected through partial pharyngectomy, and the hypopharyngeal defect reconstruction was achieved using the rolled supra-
clavicular flap via the “End to side” technique. e patient was discharged after decannulation on day 10. e 3-week barium
swallow was performed with no evidence of anastomotic leakage, and the oral feeding was started after NG tube removal. At week
5, complete movement of the true vocal cord on the one side and good phonation and deglutition was observed. ere was no
evidence of recurrence after 1 year. Conclusions. Laryngeal-preserving partial pharyngectomy and hypopharyngeal reconstruction
with the rolled supraclavicular flap via the “End to side” technique could lead to good oncological and functional outcomes in
selected cases of pyriform sinus.
1. Introduction
Hypopharyngeal squamous cell carcinoma (HSCC) is an
aggressive lesion, presenting the worst prognosis among head
and neck cancers with a 5-year survival of approximately 30%
[1–4]. Patients usually present with an advanced tumor due to
submucosal spread, leading to minimal preliminary mani-
festation, but early lymph node involvement and distant
metastasis [5, 6]. us, most patients require radical resection
(i.e., total pharyngolaryngoesophagectomy (PLE)) resulting in
high morbidity and mortality rate (e.g., permanent trache-
ostomy leading to phonation dysfunction and impaired
swallowing) [7–9]. Recently, chemoradiotherapy treatment
(CRT) has gained popularity as the primary treatment of
HSCC, although it has several limitations mainly including a
high recurrence rate, late toxicity, and short disease-free
interval [10–12].
In recent years, conservative surgeries with laryngeal
preservation protocols have been introduced as an alter-
native procedure for selected cases of invasive HSCC
[13, 14]. Partial pharyngectomy, indicated in lesions of the
pyriform sinus, is one of these procedures, leading to de-
sirable postoperative oncologic and functional outcomes
[15, 16] and a 5-year overall survival rate, disease-specific
survival rate, and successful laryngeal function preservation
of 50, 65%, and 80%, respectively [17].
Reconstruction of the hypopharyngeal defect represents
a considerable challenge for the surgeon after partial
pharyngectomy due to its circumferential nature [18]. e
ideal reconstruction would lead to normal deglutition,
Hindawi
Case Reports in Otolaryngology
Volume 2021, Article ID 6619916, 6 pages
https://doi.org/10.1155/2021/6619916