Anterior Neopharyngeal Diverticulum

by Katrina M. Jensen, Fort Worth, Texas, USA

Following the changes after total laryngectomy, the dimensions, the actual size and volume of the throat are very different from before the laryngectomy surgery. Depending on the extent of the laryngectomy surgery, the length of the pharynx as well as the diameter are changed.

It is also very common to develop an anterior “pouch” as a result of the reconstruction. This can be reported as an anterior neopharyngeal diverticulum [9]. This means that when food or liquid material move from the mouth into the throat, this new pocket can often times trap some of this material, making it difficult to pass into the esophagus and result in a sensation of a collection of material in the throat.

Just as there may be a new pocket created within the throat, there are also others that are lost during the course of a laryngectomy surgery. The previous “pockets” in the throat where food and liquid could collect between swallows are no longer present.  Without these, food may then collect at the opening to the esophagus, making it impossible for subsequent material to pass. The vallecula and pyriform sinuses are normal pharyngeal structures which can act to retain food and liquid. These are lost during the removal of the larynx and as a result, when food material doesn’t pass directly into the esophagus, (which can occur for various reasons) it no longer has these “pockets” to fall into and is much more likely to remain directly over the esophageal opening. If it is not able to pass into the esophagus, this material may serve as a “road block” so to speak, for any other food or liquid to pass.