Management of pharyngeal and esophageal stenosis

Stenosis of the pharynx or cervical esophagus often causes significant patient morbidity. Dysphagia and aspiration represent the two most serious sequelae of such strictures. A variety of processes affecting the upper aerodigestive tract may result in a pharyngeal or cervical esophageal stricture, including malignancy, previous surgery or radiation therapy, caustic ingestion, or traumatic injury. The diagnostic evaluation of stenosis of the hypopharynx and cervical esophagus includes a thorough history and physical examination, a videofluoroscopic swallowing study, occasionally additional imaging studies, and an endoscopic examination. Meticulous endoscopy is critical in determining the length and severity of the stricture, which direct further management of the stenosis. Endoscopic dilation is often sufficient treatment, but if the stenosis is severe or refractory to dilation, it may require surgical correction. When augmentation or replacement of the pharynx is required, a number of reconstructive options are available. These include pedicled myocutaneous flaps, such as the pectoralis major myocutaneous flap, free tissue transfer, such as the radial forearm free flap and, in the case of a severe pharyngeal or lower esophageal stricture, an esophagectomy with gastric pull-up reconstruction. The evaluation and treatment of pharyngeal and esophageal stenosis are reviewed in detail, including indications for endoscopic management and surgical reconstruction. Descriptions of surgical techniques are included, as well as a discussion of potential complications of treatment modalities.