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At least 19 recordsLinked to original sources
PubMed2000

The incidence and mechanisms of pharyngeal and upper esophageal dysfunction in partially paralyzed humans: pharyngeal videoradiography and simultaneous manometry after atracurium.

BACKGROUND: Residual neuromuscular block caused by vecuronium alters pharyngeal function and impairs airway protection. The primary objectives of this investigation were to radiographically evaluate the swallowing act and to record the incidence of and the mechanism behind pharyngeal dysfunction during partial neuromuscular block. The secondary objective was to evaluate the effect of atracurium on pharyngeal function. METHODS: Twenty healthy volunteers were studied while awake during liquid-contrast bolus swallowing. The incidence of pharyngeal dysfunction was studied by fluoroscopy. The initiation of the swallowing process, the pharyngeal coordination, and the bolus transit time were evaluated. Simultaneous manometry was used to document pressure changes at the tongue base, the pharyngeal constrictor muscles, and the upper esophageal sphincter. After control recordings, an intravenous infusion of atracurium was administered to obtain train-of-four ratios (T4/T1) of 0.60, 0.70, and 0.80, followed by recovery to a train-of-four ratio of more than 0.90. RESULTS: The incidence of pharyngeal dysfunction was 6% during the control recordings and increased (P < 0.05) to 28%, 17%, and 20% at train-of-four ratios 0.60, 0.70, and 0.80, respectively. After recovery to a train-of-four ratio of more than 0.90, the incidence was 13%. Pharyngeal dysfunction occurred in 74 of 444 swallows, the majority (80%) resulting in laryngeal penetration. The initiation of the swallowing reflex was impaired during partial paralysis (P = 0.0081). The pharyngeal coordination was impaired at train-of-four ratios of 0.60 and 0.70 (P < 0.01). A marked reduction in the upper esophageal sphincter resting tone was found, as well as a reduced contraction force in the pharyngeal constrictor muscles. The bolus transit time did not change significantly. CONCLUSION: Partial neuromuscular paralysis caused by atracurium is associated with a four- to fivefold increase in the incidence of misdirected swallowing. The mechanism behind the pharyngeal dysfunction is a delayed initiation of the swallowing reflex, impaired pharyngeal muscle function, and impaired coordination. The majority of misdirected swallows resulted in penetration of bolus to the larynx.

Adult↗
PubMed2000

Impact of tongue base and posterior pharyngeal wall biomechanics on pharyngeal clearance in irradiated postsurgical oral and oropharyngeal cancer patients.

BACKGROUND: Postsurgical oral and oropharyngeal cancer patients may experience pharyngeal clearance problems after completion of postoperative radiotherapy. METHODS: Swallowing was examined in six patients using videofluoroscopy for up to 1 year after surgery. Biomechanical analysis was used to mark movement of the tongue base and posterior pharyngeal wall during swallowing. RESULTS: The majority of patients experienced increased problems with pharyngeal clearance at or after their 6 month posthealing evaluation, generally 18 to 22 weeks after completion of radiotherapy. Pharyngeal residue was associated with a disruption in either tongue base or posterior pharyngeal wall movement. CONCLUSIONS: Increased fibrosis of the pharyngeal musculature after completion of radiotherapy may have a negative impact on pharyngeal clearance in addition to any pharyngeal clearance problems resulting from surgical resection. Tongue base to posterior pharyngeal wall contact is essential but not sufficient for effective pharyngeal clearance. Sufficient duration of tongue base to posterior pharyngeal wall contact is also needed to provide adequate pharyngeal bolus driving pressure.

Aged↗
PubMed2002

Intranasal immunization with lipoteichoic acid and cholera toxin evokes specific pharyngeal IgA and systemic IgG responses and inhibits streptococcal adherence to pharyngeal epithelial cells in mice.

OBJECTIVE: Streptococcus (S.) pyogenes is common cause of acute tonsillitis. Lipoteichoic acid (LTA), which is a common constitute of the cell surface of most gram positive bacteria, is known to act as a substance of bacterial site for adherence to epithelium and antiserum to LTA is reported to inhibit bacterial attachment to epithelial cells in vitro. Cholera toxin subunit B (CT-B) is known to be a mucosal adjuvant. The purpose of this study is to investigate whether intranasal immunization with LTA and CT-B may be a possible candidate for vaccine formulation. METHODS: Six-week-old male BALB/c mice were assigned to three experimental groups, mice immunized with LTA and CT-B, with LTA alone and with phosphate buffered saline (PBS) as a control. Immunizations were performed intranasally every 2 days for 2 weeks in every group. At the 21 days after immunization, sera, pharyngeal washings and pharyngeal epithelial cells were taken. The levels of serum IgG and pharyngeal IgA antibodies to LTA were measured by enzyme-linked immunosorbent assay (ELISA). The adherence rates of S. pyogenes pretreated by pharyngeal washings to pharyngeal epithelial cells from the mice were determined by in vitro adherence assay. RESULTS: The serum anti-LTA IgG antibody levels of either mice immunized with LTA and CT-B or mice immunized with LTA alone were significantly higher than those of mice administered with PBS alone. The pharyngeal anti-LTA IgA antibody levels of the mice immunized with LTA and CT-B were significantly higher than those of either mice with LTA alone or mice with PBS alone. The streptococcal adherence rates to pharyngeal epithelial cells were significantly decreased by pretreatment with pharyngeal washings from the mice immunized with LTA and CT-B as compared with pretreatment with those from either mice with PBS or mice with LTA alone. CONCLUSIONS: These data shows that intranasal immunization with LTA and CT-B evokes a good pharyngeal IgA response as well as systemic IgG response to LTA and inhibits streptococcal adherence to pharyngeal epithelial cells, suggesting that intranasal immunization with LTA and CT-B may be an effective approach to prevent streptococcal tonsillitis.

Administration, Intranasal↗
PubMed1997

The Caenorhabditis elegans NK-2 homeobox gene ceh-22 activates pharyngeal muscle gene expression in combination with pha-1 and is required for normal pharyngeal development.

Pharyngeal muscle development in the nematode Caenorhabditis elegans appears to share similarities with cardiac muscle development in other species. We have previously described CEH-22, an NK-2 class homeodomain transcription factor similar to Drosophila tinman and vertebrate Nkx2-5, which is expressed exclusively in the pharyngeal muscles. In vitro, CEH-22 binds the enhancer from myo-2, a pharyngeal muscle-specific myosin heavy chain gene. In this paper, we examine the role CEH-22 plays in pharyngeal muscle development and gene activation by (a) ectopically expressing ceh-22 in transgenic C. elegans and (b) examining the phenotype of a ceh-22 loss-of-function mutant. These experiments indicate that CEH-22 is an activator of myo-2 expression and that it is required for normal pharyngeal muscle development. However, ceh-22 is necessary for neither formation of the pharyngeal muscles, nor for myo-2 expression. Our data suggest parallel and potentially compensating pathways contribute to pharyngeal muscle differentiation. We also examine the relationship between ceh-22 and the pharyngeal organ-specific differentiation gene pha-1. Mutations in ceh-22 and pha-1 have strongly synergistic effects on pharyngeal muscle gene expression; in addition, a pha-1 mutation enhances the lethal phenotype caused by a mutation in ceh-22. Wild-type pha-1 is not required for the onset of ceh-22 expression but it appears necessary for maintained expression of ceh-22.

Animals↗
PubMed1999

Adaptation of pharyngeal wall adduction after pharyngeal flap surgery.

OBJECTIVE: The purpose of this investigation was to study lateral pharyngeal wall adduction relative to pharyngeal flaps of different widths. The hypothesis to be tested was that pharyngeal wall adduction does not increase postoperatively but may decrease due to the mechanical hindrance of a wide flap. DESIGN: In this prospective study, adaptation of lateral pharyngeal wall adduction during speech was studied relative to pharyngeal flaps of different widths utilizing videoradiography. Flap width was determined nasopharyngoscopically. SETTING: All patients were treated by the Stockholm Cleft Palate Team, Sweden. PATIENTS: Fifty-three patients were strictly selected by discarding conditions known to exert uncontrolled influence on velopharyngeal sphincter function. RESULTS: The results revealed a potential for adaptation of pharyngeal wall adduction to different flap widths. The magnitude and character (increase or decrease) of change in adduction was significantly correlated with the degree of preoperative adduction and with the width of the flap. In patients with limited preoperative adduction, pharyngeal wall activity increased, more in the presence of a narrow flap while less if the flap was wide. When preoperative adduction was pronounced, the postoperative activity decreased because of mechanical hindrance by the flap, and the degree of impediment was correlated to the width of the flap. CONCLUSION: A potential for increased lateral pharyngeal wall adduction after pharyngeal flap surgery was verified, but the result cannot be interpreted as generally applicable because of the strict selection of patients.

Adaptation, Physiological↗
PubMed2001

[The relationship between content of substance P, VIP in pharyngeal tissue and narrow pharyngeal cavity of patients with OSAS].

OBJECTIVE: To investigate the relationship between content of substance P, VIP in the pharyngeal tissue and narrow pharyngeal cavity of patients with OSAS. METHOD: By using semi-quantitative immunohistochemical method, resected pharyngeal tissue from 30 patients with OSAS and 12 normal health adult controls were investigated with rabbit anti-substance P and rabbit anti-VIP. RESULT: SP and VIP were detected in tribution within the epithelium or between epithelium cells, around the pharyngeal glands and gland ducts, around endothelium cells and smooth muscle of blood vessels. SP and VIP levels in pharyngeal tissue of the patients with OSAS were increased than those of the controls. CONCLUSION: Narrow of pharyngeal cavity with OSAS was relative to edema of pharyngeal tissue induced by increased SP and VIP in pharyngeal tissue. A neurogenic inflammation was one of the factors of OSAS.

Adult↗
PubMed1990

Group A streptococcal pharyngeal carriage, pharyngitis, and impetigo in two northern Canadian native communities.

The prevalence of pharyngeal carriage of group A streptococci, streptococcal pharyngitis, and impetigo was determined in schoolchildren in two northern communities, one Inuit (mean number of schoolchildren surveyed, 233) and one native Indian (mean number of schoolchildren surveyed, 349). At three surveys from November 1984 to May 1985, pharyngeal group A streptococcal carriage was 5.3%, 22%, and 34% in the Inuit community and 5.3%, 5.1% and 10% in the native Indian, with impetigo prevalence 1.6%, 3.8% and 1.0%, and 2.4%, 4.2% and 0.6%, respectively. Increased pharyngeal carriage correlated with the increasing number of household residents and the lower school grade. In 12 months of observation the incidence of group A streptococcal pharyngitis was 49/100 schoolchildren for the Inuit and 9.4/100 for the native Indian community, with impetigo 13/100 and 11/100 respectively. The maximal incidence of pharyngitis was late winter in the Inuit community and midsummer in the native Indian. The incidence of impetigo peaked in January for both communities. M and T typing showed consecutive outbreaks of different serotypes in the Inuit community, but a persistent low level of endemic infection in the Indian community. These observations suggest a seasonal prevalence of group A streptococcal pharyngeal carriage consistent with other North American populations, but marked inter-community variation in pharyngeal carriage and disease. The midwinter peak of impetigo appears unique to these populations.

Adolescent↗
PubMed2001

Pharyngeal function and airway protection during subhypnotic concentrations of propofol, isoflurane, and sevoflurane: volunteers examined by pharyngeal videoradiography and simultaneous manometry.

BACKGROUND: Anesthetic agents alter pharyngeal function with risk of impaired airway protection and aspiration. This study was performed to evaluate pharyngeal function during subhypnotic concentrations of propofol, isoflurane, and sevoflurane and to compare the drugs for possible differences in this respect. METHODS: Forty-five healthy volunteers were randomized to receive propofol, isoflurane, or sevoflurane. During series of liquid contrast bolus swallowing, fluoroscopy and simultaneous solid state videomanometry was used to study the incidence of pharyngeal dysfunction, the initiation of swallowing, and the bolus transit time. Pressure changes were recorded at the back of the tongue, the pharyngeal constrictor muscles, and the upper esophageal sphincter. After control recordings, the anesthetic was delivered, and measurements were made at 0.50 and 0.25 predicted blood propotol concentration (Cp50(asleep)) for propofol and 0.50 and 0.25 minimum alveolar concentration (MAC)(awake) for the inhalational agents. Final recordings were made 20 min after the end of anesthetic delivery. RESULTS: All anesthetics caused an increased incidence of pharyngeal dysfunction with laryngeal bolus penetration. Propofol increased the incidence from 8 to 58%, isoflurane from 4 to 36%, and sevoflurane from 6 to 35%. Propofol in 0.50 and 0.25 Cp50(asleep) had the most extensive effect on the pharyngeal contraction patterns (P < 0.05). The upper esophageal sphincter resting tone was markedly reduced from 83 +/- 36 to 39 +/- 19 mmHg by propofol (P < 0.001), which differed from isoflurane (P = 0.03). Sevoflurane also reduced the upper esophageal sphincter resting tone from 65 +/- 16 to 45 +/- 18 mmHg at 0.50 MAC(awake)(P = 0.008). All agents caused a reduced upper esophageal sphincter peak contraction amplitude (P < 0.05), and the reduction was greatest in the propofol group (P = 0.002). CONCLUSION: Subhypnotic concentrations of propofol, isoflurane, and sevoflurane cause an increased incidence of pharyngeal dysfunction with penetration of bolus to the larynx. The effect on the pharyngeal contraction pattern was most pronounced in the propofol group, with markedly reduced contraction forces.

Anesthetics, Inhalation↗
PubMed1997

Regulation of the phosphorylation of human pharyngeal cell proteins by group A streptococcal surface dehydrogenase: signal transduction between streptococci and pharyngeal cells.

Whether cell-to-cell communication results when group A streptococci interact with their target cells is unknown. Here, we report that upon contact with cultured human pharyngeal cells, both whole streptococci and purified streptococcal surface dehydrogenase (SDH) activate pharyngeal cell protein tyrosine kinase as well as protein kinase C, thus regulating the phosphorylation of cellular proteins. SDH, a major surface protein of group A streptococci, has both glyceraldehyde-3-phosphate dehydrogenase and ADP-ribosylating enzyme activities that may relate to early stages of streptococcal infection. Intact streptococci and purified SDH induce a similar protein phosphorylation pattern with the de novo tyrosine phosphorylation of a 17-kD protein found in the membrane/particulate fraction of the pharyngeal cells. However, this phosphorylation required the presence of cytosolic components. NH2-terminal amino acid sequence analysis identified the 17-kD protein as nuclear core histone H3. Both phosphotyrosine and phosphoserine-specific monoclonal antibodies reacted with the 17-kD protein by Western blot, suggesting that the binding of SDH to these pharyngeal cells elicits a novel signaling pathway that ultimately leads to activation of histone H3-specific kinases. Genistein-inhibitable phosphorylation of histone H3 indicates that tyrosine kinase plays a key role in this event. Treatment of pharyngeal cells with protein kinase inhibitors such as genistein and staurosporine significantly inhibited streptococcal invasion of pharyngeal cells. Therefore, these data indicated that streptococci/SDH-mediated phosphorylation plays a critical role in bacterial entry into the host cell. To identify the membrane receptor that elicits these signaling events, we found that SDH bound specifically to 30- and 32-kD membrane proteins in a direct ligand-binding assay. These findings clearly suggest that SDH plays an important role in cellular communication between streptococci and pharyngeal cells that may be important in host cell gene transcription, and hence in the pathogenesis of streptococcal infection.

Amino Acid Sequence↗
PubMed1999

Mechanical effects of pharyngeal constrictor activation on pharyngeal airway function.

The mechanical effects of pharyngeal constrictor (PC) muscle activation on pharyngeal airway function were determined in 20 decerebrate, tracheotomized cats. In 10 cats, a high-compliance balloon attached to a pressure transducer was partially inflated to just occlude the pharyngeal airway. During progressive hyperoxic hypercapnia, changes in pharyngeal balloon pressure were directly related to phasic expiratory hyopharyngeus (middle PC) activity. In two separate protocols in 10 additional cats, the following measurements were obtained with and without bilateral electrical stimulation (0.2-ms duration, threshold voltage) of the distal cut end of the vagus nerve's pharyngeal branch supplying PC motor output: 1) pressure-volume relationships in an isolated, sealed upper airway at a stimulation frequency of 30 Hz and 2) rostrally directed axial force over a stimulation frequency range of 0-40 Hz. Airway compliance determined from the pressure-volume relationships decreased with PC stimulation at and below resting airway volume. Compared with the unstimulated condition, PC stimulation increased airway pressure at airway volumes at and above resting volume. This constrictor effect progressively diminished as airway volume was brought below resting volume. At relatively low airway volumes below resting volume, PC stimulation decreased airway pressure compared with that without stimulation. PC stimulation generated a rostrally directed axial force that was directly related to stimulation frequency. The results indicate that PC activation stiffens the pharyngeal airway, exerting both radial and axial effects. The radial effects are dependent on airway volume: constriction of the airway at relatively high airway volumes, and dilation of the airway at relatively low airway volumes. The results imply that, under certain conditions, PC muscle activation may promote pharyngeal airway patency.

Animals↗
PubMed1995

[Beta-lactamase producing bacteria in the pharyngeal flora of patients with acute pharyngitis].

BACKGROUND: Production of beta-lactamase by normal pharyngeal flora could account for penicillin treatment failure in patients with acute streptococcal pharyngitis. The aim of the present investigation was to study the beta-lactamase-producing bacteria (BLPB) in 58 patients with acute pharyngitis, and to investigate the impact of two antibiotics, amoxycillin vs amoxycillin/clavulanic acid in the pharyngeal microflora. METHODS: Rapid antigen detection tests for S. pyogenes and standard microbiologic cultures were performed on simultaneously obtained throat swabs from each enrolled patient. Patients with group A streptococcal pharyngitis (GASP) were randomized in two groups: patients treated with 10 days of oral amoxycillin (group I), and patients treated with 10 days of oral amoxicyllin/clavulanic acid (group II). Patients without GASP and without antibiotic treatment were considered as controls (group III). Cultures were repeated 15 days following the first culture. All of them were processed for aerobic and anaerobic organisms. RESULTS: S. pyogenes was recovered in 25 patients (43.1%) and BLPB were isolated in 64% of the treated patients and in 78% of the non-treated control patients. We observed that the number of patients harboring BLPB did not change significantly in the untreated control group. After treatment we detected a similar increase in the number of patients harboring BLPB in groups I and II. In the present study BLPB were found in more than 70% of the patients and the failure rate was less than 10%. CONCLUSIONS: The results of this study indicate that production of beta-lactamase by pharyngeal organisms does not fully explain the failures of penicillin therapy for acute streptococcal pharyngitis.

Acute Disease↗
PubMedDate not supplied

The IPA categories "pharyngeal" and "epiglottal": laryngoscopic observations of pharyngeal articulations and larynx height.

The phonetic problem is to describe accurately the articulatory mechanism, or mechanisms, responsible for the production of a series of sounds that are presently labelled on the chart of the International Phonetic Association as either pharyngeal or epiglottal. The sounds on which these categories are based are found in the Semitic languages, in the languages of the Caucasus, and in the languages of the Pacific Northwest coast of North America. In order to reconcile a variety of descriptive terms with a logical phonetic taxonomy, auditorily distinguishable parameters are deduced from a naturally occurring variety of sounds, isolated articulatorily, and observed with a fibreoptic laryngoscope to define a cardinal set of articulatory possibilities. Auditory comparisons with database illustrations of the sounds of various languages inform the production of cardinal values in the laryngoscopic study. Voiceless pharyngeals (fricatives) are identified by aryepiglottic fold constriction and a medial aperture. Voiced pharyngeals (approximants) are identified by aryepiglottic fold constriction and a covered glottis. Trilling can occur laterally along the aryepiglottic folds in either voiceless (fricative) or voiced (approximant) mode. A pharyngeal plosive is identified by full occlusion of the aryepiglottic sphincter. "Epiglottal" sounds, which have been described auditorily as "deeper" or "more extreme" than pharyngeals, are associated with either the trilled varieties of the simple fricative or approximant, or the default raised larynx posture of the aryepiglottic sphincter, with radical retraction of the tongue. They are therefore more severely constricted, but not physiologically "deeper" than simple [symbol: see text] or [symbol: see text]. Pharyngeal articulations may also be produced with larynx lowering. Voiceless pharyngeal [symbol: see text] may be accompanied by lowering of the larynx to distinguish it from a larynx-raised [H] variant. Larynx height variations are also found in "tense/lax" register distinctions.

Epiglottis↗
PubMed1993

[Pharyngeal cross-sectional area and pharyngeal compliance in normal Japanese males and females].

It is reported that obstructive sleep apnea syndrome (OSAS) has a marked elderly male predominance and that patients with OSAS have reduced pharyngeal cross-sectional area and increased pharyngeal collapsibility. These reports suggest that the size and mechanical properties of the pharynx have sex- and age-related differences even in normal subjects. However, there are only a few reports on normal values of pharyngeal cross-sectional area and compliance. The purpose of this study was to determine the normal values of the pharyngeal cross-sectional area and compliance in Japanese healthy subjects and to determine sex-related differences and the effect of age, body size, and body posture on these parameters. We examined 181 subjects with an age range spanning 21-69 years, with normal range of body mass index and without enlarged tonsils or jaw retrusion. No subject complained of symptoms suggestive of OSAS. We measured the pharyngeal cross-sectional area in three body positions (sitting, lateral and supine) using the acoustic reflection technique (AAAR). Fifty airway area versus distance functions with a rate of 3 times per second were measured and averaged in each body position during normal breathing of room air. After identifying the fauces and the glottis on the averaged area versus distance function, we defined a region between 2 cm distal to the fauces and 2 cm proximal to the glottis as a pharyngeal segment and computed the mean area of that segment (mean pharyngeal cross-sectional area).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1980

The role of lateral pharyngeal wall movement in pharyngeal flap surgery.

A total of 202 patients with pharyngeal flaps were assessed with nasopharyngoscopy and multiview fluoroscopy to determine the role of lateral pharyngeal wall movement postoperatively. Variations in the construction of flaps resulted in three categories: namely, a long narrow flap with a high insertion, a short broad flap with a low insertion, and an intermediate-size flap that is inserted in a position somewhere between the first two. It was found that in all cases where there was no evidence of velopharyngeal insufficiency, the sole determiner of velopharyngeal closure was the medical excursion of the lateral pharyngeal walls to the sides of the flap. In flap failures, the causes for velopharyngeal insufficiency were inappropriate degree, level, and symmetry of the lateral pharyngeal wall motion. The success of pharyngeal flap surgery depends largely on the preoperative assessment of the velopharyngeal mechanism and the choice of a type of pharyngeal flap that will best assist closure of the velopharyngeal port during speech.

Evaluation Studies as Topic↗
PubMed1980

The effect of pharyngeal flap surgery on the movements of the lateral pharyngeal walls.

Observations of prepharyngeal and postpharyngeal flap degrees of lateral pharyngeal wall movement seem to indicate that some individuals have the ability to alter patterns of lateral pharyngeal wall motion. However, most of the subjects did not show changes in lateral pharyngeal wall motion, and in those who did show changes, the effects of speech therapy could not be excluded. Therefore, the suggestion that pharyngeal flaps should be "tailored" to the size of the gap in the velopharyngeal sphincter seems valid. Or, to put it differently, it seems likely that in many individuals, if the pharyngeal flap constructed is not as broad as the velopharyngeal gap, velopharyngeal insufficiency and hypernasality are likely to persist because most often the lateral pharyngeal wall movement will not adapt to the presence of a new structure in the pharynx.

Endoscopy↗
PubMed1997

Swallowing and pharyngeal function in postoperative pharyngeal cancer patients.

This study examines the pharyngeal phase of swallowing after the resection of pharyngeal cancer, and focuses on the pharynx as a functional organ. The purpose of the study was to obtain information on both reconstruction and rehabilitation in cases of surgically treated pharyngeal cancer. The records of 21 consecutive patients who underwent surgical treatment of oropharyngeal and hypopharyngeal squamous cell carcinoma between 1990 and 1993 were reviewed. Functional results following surgery were graded on a numerical scale in three categories: pharyngeal swallow, laryngeal and lower airway protection, and oral alimentation. Three treatment groups were observed: group 1 = transoral excision with primary closure (six patients); group 2 = composite resection with primary closure (nine patients); and group 3 = composite resection with deltopectoral or pectoralis major flap closure (six patients). Comparison of pharyngeal swallow and laryngeal protection functions showed no significant difference between the three groups. However, oral alimentation performance in group 1 was significantly better than in group 3, and groups 1 and 2 achieved a similar level. In patients with T3 and T4 tumors postoperative function was poor and no difference in postoperative function was demonstrated between patients undergoing reconstruction with primary closure and patients undergoing reconstruction with deltopectoral or pectoralis major flaps. Patients with T3 and T4 tumors experienced impaired postoperative function regardless of the method of reconstruction used. This is not a condemnation of the surgical treatment of advanced pharyngeal tumors, but rather a suggestion that other reconstruction techniques be considered.

Aged↗