Background & Aim:

Pharyngocutaneous fistula (PCF) is the most common complication following salvage laryngectomy (SLE). The preventive use of a pectoralis major flap (PMF) is one strategy to reduce the incidence of PCF. The aim of this study was to evaluate whether the use of PMF in SLE reduces the incidence of PCF.

Material & Methods:

In this retrospective study, patients who underwent SLE were divided into two groups according to the presence or absence of PCF. The groups were compared with respect to the use of PMF using the chi-square and Fisher’s exact tests.

Results:

PCF developed in 39.3% of patients after SLE. Overall, a PMF was used in 34 patients (23.3%), including seven cases (20.6%) in which it was applied prophylactically. The use of PMF did not significantly reduce the incidence of PCF (p = 0.407). Furthermore, no significant differences were found between prophylactic and reconstructive use of PMF (p = 0.427 and p = 0.353, respectively).

Conclusions:

In our series, the preventive use of PMF in SLE did not reduce the incidence of PCF. However, the literature largely supports the effectiveness of vascularized flaps in preventing PCF; therefore, when risk factors are carefully considered, routine use of PMF remains justified.

Description and Background: Transoral laser microsurgery (TLM) is a well-established organ-preserving treatment modality for selected laryngeal cancers, offering excellent oncologic outcomes with favorable functional results when applied with appropriate patient selection and meticulous surgical technique. This instructional course will provide a practical and step-by-step overview of transoral laser surgery for supraglottic and glottic laryngeal cancers, focusing on indication criteria, exposure strategies, laser settings, and resection techniques. Key technical aspects such as en bloc versus multi-bloc resection, margin assessment, management of close or positive margins, and decision-making in cases with challenging exposure will be discussed. Surgical videos and representative clinical cases will be used to demonstrate operative nuances, common pitfalls, and complication management, including bleeding, airway compromise, and aspiration. The course will also address the integration of TLM into multidisciplinary treatment planning, including the role of neck management, adjuvant therapy, and follow-up strategies.

Outcome Objectives: At the end of this course, participants will be able to:

- Identify appropriate indications and contraindications for TLM in laryngeal cancer
- Understand key technical steps and laser safety principles
- Apply oncologic concepts of margin control in transoral resections
- Recognize and avoid common technical and oncologic pitfalls
- Integrate TLM into a multidisciplinary treatment strategy for laryngeal cancer