Swallowing problems following total laryngectomy are significantly lesser compared to other partial laryngectomies as a permanent seperation between the trachea and esophagus is seen in the earlier. Sometimes, the patient complains of difficulty in propelling bolus through the oral cavity and pharynx as a result of the loss of hyoid bone, which is the anchor for the tongue. The increased pressure in the narrowed pharyngoesophageal segment following laryngectomy requires the tongue to move with greater force.

Department of Head and Neck Oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru.

A 52-year-old man with history of difficulty and pain while swallowing and diagnosed as squamous cell carcinoma of the right pyriform fossa extending to the pharyngoepiglottic fold. Incidently, the patient had an old untreated cleft palate. Assessment of the pharyngeal wall involvement on direct laryngoscopy proved that pectoralis major myocutaneous flap patch was needed to reconstruct the pharyngeal lumen. Cleft palate proved a contraindication for surgery as the oral swallowing phase would be affected.

Current management protocols of hypopharyngeal cancers include multifactorial assessment of anatomical and functional outcomes and rehabilitation. Even though no literature is found stating cleft palate as the contraindication for total laryngectomy, chemoradiation was preferred citing swallowing problems.

Naik SM. Untreated Cleft Palate a Unique Surgical Contraindication in Carcinoma of the Pyriform Fossa. Int J Phonosurg Laryngol 2012;2(1):33-36.