Stenosis of the hypopharyngo-oesophageal junction can be a rare complication of
laryngectomy and/or partial
pharyngectomy and makes the insertion of
voice prosthesis extremely difficult. This study describes the authors' experiences gained by endoscopic balloon-
catheter dilatation of hypopharyngo-oesophageal
stenoses prior to implantation of
voice prostheses in four cases. In two patients a single balloon-
catheter dilatation resulted in wide enough pharyngo-oesophageal lumen on the long run. The average
prosthesis wearing-times were 6.8 months in case 1 and 4.6 months in case 2, corresponding to the published literature data. In case 3, repeated dilatation of the pharyngo-oesophageal transition had proved to be unsuccessful despite taking every effort with the endoscopic balloon-
catheter method. Having excised the stenotic segment, reconstruction with pectoralis major
myocutaneous flap (PMMF) was indicated. Eighteen months later, a repeated restenosis was observed and a free jejunal flap needed to be performed as a final
solution. In case 4, the insertion was carried out into a previously dilated jejunal
free flap, which became gradually ischemic and stenotic since the major head-and neck procedure was carried out that resulted in
prosthesis rejection after just 1 week. The authors emphasize that correct indication of pedicled and
free flaps in head and neck reconstruction is a prerequisite from the aspect of prevention of pharyngo-oesophageal
strictures. Endoscopic balloon-
catheter dilatation is a safe and established method for dilatating hypopharyngo-oesophageal
stenoses of different origin. The procedure provides maximum patient benefit with minimal
trauma and morbidity; moreover, facilitates insertion of
voice prostheses. However, a single balloon-
catheter dilatation cannot always result in wide enough oesophageal lumen on the long run (case 3). Insertion of a
voice prosthesis into a previously dilated ischemic jejunal segment is challenging and avoidable due to risks of complications.