584 Innovative Role for Salivary Bypass Tube Insertion in the Holistic Palliative Management of Neopharyngeal Stenosis following Laryngectomy
N Wang, C Soon, C Board, P RocheAbstract
Background
Neopharyngeal stenosis following laryngectomy has a significant impact on patient quality of life following treatment for laryngeal cancer. It is challenging to manage, particularly in palliative patients, for whom reconstructive options are limited when standard approaches with repeat dilation fails. When occurringalongside recurrent local or metastatic disease, free flap reconstruction for neopharyngeal stenosis is often not in the patients' best interest, yet immunotherapy can potentially prolong life for many months. In select patients, a modified Montgomery salivary bypass tube (SBT) may be used to retain speech and swallowing function whilst undergoing palliative non-surgicaltreatments or clinical trials.
Case Summary
A 73-year-old male was referred with severe recurrent neopharyngeal stenosis following total laryngectomy for hypopharyngeal SCC which developed 8 years post chemoradiotherapy for tonsil cancer. His symptoms weretotal dysphagia requiring RIG insertion, and inability to use his speech valve. On re staging, he was found to have a separate recurrence in the neck, and multiple pulmonary metastases. To restore his ability to swallow and communicate, he underwent dilation of the neopharynx, and a shortened Montgomery SBT with tailored flange was inserted. The tube was replaced regularly every 4 weeks, with further modifications as required to optimise comfort and minimise posterior pharyngeal wall irritation. He underwent palliative chemotherapy, followed by nivolumab and remains alive, well, able to both speak and eat, 12 months after initial presentation.
Conclusions
Modified SBT can offer viable swallowing and voicing palliation in neopharyngeal stenosis patients; improving quality of life with manageable side effects.