OBJECTIVES: To map mechanoreceptor response in various regions of the laryngopharynx. METHODS: Five patients with suspected laryngopharyngeal reflux and six healthy control subjects underwent stimulation of mechanoreceptors in the hypopharynx, interarytenoid area, arytenoids, aryepiglottic folds, and pyriform sinuses. The threshold stimuli evoking sensation and eliciting laryngeal adductor reflex were recorded. RESULTS: In controls, an air pulse with 2 mmHg pressure evoked mechanoreceptor response in all regions, except bilateral aryepiglottic folds of one control. In patients, stimulus intensity to elicit mechanoreceptor response ranged between 2 mmHg and 10 mmHg and varied among the regions. Air pulse intensity differed between right and left sides of laryngopharyngeal regions in the majority of patients. CONCLUSION: Laryngopharyngeal mechanoreceptor response was uniform among regions and subjects in the healthy group. Patients with suspected laryngopharyngeal reflux showed inter- and intra-regional variations in mechanoreceptor response. Laryngopharyngeal sensory deficit in patients with suspected laryngopharyngeal reflux is not limited to aryepiglottic folds.
Humans ; Hypopharynx ; Laryngopharyngeal Reflux ; Mechanoreceptors* ; Pyriform Sinus ; Reflex ; Sensation

A retrospective review of fifty patients with carcinoma of hypopharynx treated with RT+/-surgery was studied for eleven-year period from 1974 to 1984. Of the 50 patients, 46 were pyriform sinus in origin, 4 were posterior pharyngeal wall. Eighty-eight percent of patients were locoregionally advance (stage III, IV) and 78% of patients presented cervical lymphadenopathy. 5-year disease-free survival rate of the pyriform sinus ca. was 25.4% in RT alone group, 80% in combined modality group and 30.6% in overall. Local control rate with RT alone in early stage (II) was excellent (100%), however combined modality appears to be better for local control (80%) in advanced stage (III, IV) as compared with that of RT alone group (32%). On basis of this study, RT alone is effective in terms of local control and functional preservation in treatment of early stage of pyriform sinus ca. while surgery can be reserved for salvage purpose when RT fails and combined modality is recommended in patients with locally advanced stage for better local control and survival.
Disease-Free Survival ; Humans ; Hypopharynx ; Lymphatic Diseases ; Pyriform Sinus ; Radiotherapy ; Retrospective Studies

We describe a case of venous malformation of pyriform sinus in 63 year-old patient, discovered incidentally. Venous malformation are the most common vascular malformations to arise in the head and neck. However venous malformation of the hypopharynx in the adult papulation are rare. The author performed successfully ethanol sclerotherapy for venous malformation of pyriform sinus, so we present the case with a review of the related literatures.
Adult ; Ethanol* ; Head ; Humans ; Hypopharynx ; Neck ; Pyriform Sinus* ; Sclerotherapy* ; Vascular Malformations

The ductal cyst of the hypopharynx is a very rare tumor. We report a case of hypopharyngeal ductal cyst in a 63-year-old man presenting with globus sensation. It was removed by a laryngomicrosurgical technique, using a microdissection electrode. Masses of the hypopharynx may not always be easily visible on routine examination of the hypopharynx with flexible fiberoptic laryngoscopes. Particularly in cases of benign tumors, the diagnosis may be delayed due to a prolonged history of mild and subtle symptoms. We missed the hypopharyngeal mass at the initial presentation, but could detect the mass in the pyriform sinus with a double contrast barium swallow study. We describe the diagnostic method to detect hypopharyngeal tumors and the treatment of benign hypopharyngeal masses.
Barium ; Diagnosis ; Electrodes ; Humans ; Hypopharynx ; Laryngopharyngeal Reflux* ; Laryngoscopes ; Microdissection ; Middle Aged ; Pyriform Sinus ; Sensation

BACKGROUND AND OBJECTIVES: Radical surgery with radiotherapy is regarded as a standard treatment modality of hypopharyngeal squamous cell carcinoma. However, reports on results of treatment and patterns of failure after surgery for hypopharyngeal cancer are lacking. PATIENTS AND METHODS: From July 1992 to December 1998, 39 previously untreated hypopharyngeal carcinoma patients were treated with surgery with or without postoperative radiotherapy at Severance Hospital. Ten were treated with surgery alone, RESULTS: The overall 5-year survival rate was 58.1%, of which 47.2% accounted for the group who received surgery only and 64.6% for the group who received surgery plus postoperative radiotherapy. Survival was best for posterior pharyngeal wall cancer (64.6%) and worst for pyriform sinus cancer (56.1%). Recurrence was noted in 31% (12/39) of the cases. The most common Failure site was the neck, Among the neck failures, three unusual retropharyngeal and paratracheal nodal failures were noted. CONCLUSION: Treatment with radical surgery may improve survival of patients with this notorious cancer. The extent of neck dissection for hypopharyngeal carcinoma may need to be evaluated with future trials. (Korean J Otolaryngol 2000; 43: 528-34)
Carcinoma, Squamous Cell* ; Humans ; Hypopharyngeal Neoplasms ; Hypopharynx* ; Neck ; Neck Dissection ; Pyriform Sinus ; Radiotherapy ; Recurrence ; Survival Rate

Synovial sarcoma of the hypopharynx is an uncommon malignancy, with less than 100 cases reported in available journals. We report a case of a 22-year-old female presenting with dysphagia and enlarging hypopharyngeal mass, clinically diagnosed as hypopharyngeal malignancy, right, at least stage III. Histopathologic examination including immunohistochemistry study with TLE1 and SS18 Fluorescence In Situ Hybridization (FISH) confirm the diagnosis of synovial sarcoma. This is the first reported case of synovial sarcoma of the hypopharynx in the Philippines confirmed by SS18 FISH. Due to the size of the mass, chemoradiotherapy followed by surgery is the current plan of management for this patient.
Sarcoma ; Hypopharynx

Pyriform sinus perforation is uncommon in children and most cases are secondary to iatrogenic causes such as endotracheal intubations. Due to this rarity, the management of these injuries is controversial. We report a case of pyriform sinus perforation in a 14-month-old boy who fell down with a spoon handle in the mouth and was successfully treated by transoral laryngomicrosurgery. Two hours after falling down, the patient had breathing difficulties and started vomiting. A chest X-ray showed subcutaneous emphysema and pneumomediastium. Esophagogram revealed leakage of contrast media at the hypopharynx. Although air leakage was reduced the next day, his fever became frequent even with conservative management of antibiotics. On the 4th hospital day, closure of pyriform sinus perforation was done by transoral laryngomicrosurgery. The patient became apyrexial by the 2nd post-operative day. On the 21th hospital day, the child was able to consume food orally without problems and was allowed to go home.
Anti-Bacterial Agents ; Child ; Contrast Media ; Fever ; Humans ; Hypopharynx ; Intubation, Intratracheal ; Mouth ; Pyriform Sinus ; Respiration ; Subcutaneous Emphysema ; Thorax ; Vomiting

Between 1987 and 1995, eleven patients with severe chronic corrosive stenosis of the hypopharynx and esophagus underwent surgical restoration of digestive continuity at Inje University Seoul Paik Hospital. There were 7 male and 4 female patients aged from 21 to 47 years (mean, 34 years). The caustic material was acid in 6 patients and alkali in 5 patients. The esophagus was reconstructed using the right colon in 9 and left colon in 2. The cervical approach and the side of proximal anastomosis depended on the status of the pyriform sinus of the hypopharynx. In the neck, J-formed incision was made along the sternocleidomastoid muscle. The sternohyoid and thyrohyoid muscles were divided transversely to expose the thyroid cartilage. Hypopharyngeal opening for proximal anastomosis was made by reverse triangular formed resection of the thyroid cartilage after elevation of perichondrium. Immediately after operation, dysphagia and aspiration into trachea were common, so training of swallowing was required. Feeding gastrostomy was usually maintained for 3 months until restoration of swallowing function was confirmed. There was graft necrosis in 3 patients, who were treated with jejunal free graft. Revisional procedures for stenosis of cervical anastomosis in 3 patients consisted of widening of pharyngocecostomy site in 2 and resection of adhesive band in one. Return of normal swallowing assuring normal nutrition was obtained in 10 of 11 cases.
Adhesives ; Alkalies ; Colon ; Constriction, Pathologic* ; Deglutition ; Deglutition Disorders ; Esophageal Stenosis ; Esophagus ; Female ; Gastrostomy ; Humans ; Hypopharynx ; Male ; Muscles ; Neck ; Necrosis ; Pyriform Sinus ; Seoul ; Thyroid Cartilage ; Trachea ; Transplants

OBJECTIVES: Endoscopic laryngopharyngeal surgery (ELPS) is a minimally invasive transoral surgery that was developed to treat superficial larygo-pharyngeal cancer, in which a mucosal lesion is resected transorally while preserving deeper structures by subepithelial injection. The purpose of this retrospective study is to evaluate voice outcome in patients who underwent ELPS for superficial hypopharyngeal cancer. As important structures in producing voice, such as intrinsic laryngeal muscles, their fascia, and recurrent laryngeal nerve, are located in the medial side of the piriform sinus and the postcricoid region of the hypopharynx, we focused on patients with cancer lesions involving these regions. METHODS: From April 2010 to March 2011, 25 consecutive patients with superficial laryngopharyngeal cancer were treated with ELPS at Kyoto University Hospital. Among the 25 patients, 11 patients with cancer lesions on the medial side of the piriform sinus or the postcricoid area were studied. Preoperative and postoperative voice functions including maximum phonation time (MPT), mean flow rate (MFR), jitter, shimmer, soft phonation index (SPI), and noise-to-harmonic ratio (NHR), were compared retrospectively. RESULTS: Five of 11 cancer lesions had submucosal invasion and no lesion had invaded the muscular layer pathologically. T stage was classified as Tis in 5 cases, T1 in 4 cases, and T2 in 2 cases. All lesions involved the medial side of the piriform sinus and 2 also involved the postcricoid area. Vocal fold movement was normal in all cases after the surgery. Average preoperative and postoperative values for MPT, MFR, jitter, shimmer, SPI, and NHR, were 22.7 seconds and 23.4 seconds, 165 mL/sec and 150 mL/sec, 1.53% and 1.77%, 3.82% and 5.17%, 35.5 and 36.6, and 0.13% and 0.14%, respectively. There was no statistical difference between preoperative and postoperative data for all values examined. CONCLUSION: ELPS is useful in preserving voice function in the treatment of superficial hypopharyngeal cancer. Preserving the deeper structures including intrinsic muscles and their fascia may be important for preserving voice function as long as the lesions are superficial.
Fascia ; Humans ; Hypopharyngeal Neoplasms* ; Hypopharynx ; Laryngeal Muscles ; Muscles ; Narrow Band Imaging ; Phonation ; Pyriform Sinus ; Recurrent Laryngeal Nerve ; Retrospective Studies ; Vocal Cords ; Voice*

Partial laryngectomy and pharyngectomy have been suggested for localized hypopharyngeal cancer to preserve the function of larynx. In case of limited partial laryngectomy, local soft tissue flaps are sufficient to provide adequate bulk for glottic closure. However, in case of extensive partial laryngectomy procedure in which more cartilaginous framework is resected, we feel an increased necessity of considering 'hard tissue' as well as soft tissue restoration to prevent airway collapse and glottic incompetency. We have tried radial forearm free flap including palmaris longus tendon for reconstruction of glottis and hypopharynx following a wide vertical hemilaryngopharyngectomy. We had 2 patients with hypopharyngeal cancers localized in pyriform sinus. The tendon was secured so as to drill holes in the cricoid and thyroid cartilage at the glottic level to help maintain the position of soft tissue lining and sewe as buttress for mobile vocal cord. A good restored phonation and respiration were obtained in two cases of hypopharyngeal cancer patients. But one patient suffered from frequent aspiration due to esophageal inlet stricture after radiation therapy.
Bays ; Constriction, Pathologic ; Forearm* ; Free Tissue Flaps* ; Glottis* ; Humans ; Hypopharyngeal Neoplasms ; Hypopharynx ; Laryngectomy ; Larynx ; Pharyngectomy ; Phonation ; Pyriform Sinus ; Respiration ; Tendons ; Thyroid Cartilage ; Vocal Cords