Carcinoma of the posterior pharyngeal wall

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By far the majority of malignancies involving the posterior pharyngeal wall do so by extension from, or in conjunction with, primary lesions of nearby structures, such as the tonsil, base of tongue, or larynx. On occasion, however, there will be encountered isolated malignancies of the pharyngeal wall without direct involvement or adjacent structures. In all but the smallest of such lesions, adequate exposure for surgical excision has been difficult to obtain and it has generally been considered necessary to sacrifice the larynx, even in those cases in which it was not directly involved.1 Experience with surgical management of these lesions has suggested that both excellent exposure and preservation of the larynx can be achieved by employing one of three surgical approaches.

Background and surgical considerations

Until recently, most reports on carcinoma of the pharynx have not separated lesions of the pyriform sinus, vault of the nasopharynx and of tonsillar origin from those involving the pharyngeal wall proper.1–3 Wilkins,4 in 1971, reported an overall survival rate of 36.4% for isolated pharyngeal wall lesions, regardless of treatment modality. However, the survival rate for those managed by definitive surgical excision was 62.5%. Ballantyne1, in a similar series, obtained a 50% survival rate for primary surgical patients. Although both these series are small, they indicate that primary surgical management, with or without planned preoperative radiotherapy, may offer better hope for cure than primary radiotherapy, with surgery reserved for still operable failures.

The majority of malignancies of the posterior pharyngeal wall are epidermoid. . . .



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