Hipofarinks ve Servikal Özofagus Hastalıkları
Özet
Hipofarinks ve servikal özofagus, kompleks anatomileri ve yutma ile konuşma gibi kritik fizyolojik fonksiyonları nedeniyle tıp dünyasında büyük önem taşımaktadır. Bu bölgelerin hastalıkları nadir görülmekle birlikte, yüksek morbidite ve mortalite oranlarına yol açtığından multidisipliner bir tedavi yaklaşımı gerektirmektedir. Bölüm kapsamında, anatomik sınırların yanı sıra neoplastik ve non-neoplastik hastalıklar güncel bilgiler ışığında incelenmiştir. Non-neoplastik hastalıklar arasında Killian üçgeninden köken alan Zenker divertikülü başta olmak üzere faringoözofagiyal divertiküller, yabancı cisimler, krikofaringeal disfaji, Plummer-Vinson sendromu ve laringofaringeal reflü yer almaktadır. Neoplastik hastalıklar grubunda ise %95’i skuamoz hücreli karsinom olan hipofarinks kanseri ile servikal özofagus kanseri ele alınmıştır. Bu kanserler, zengin lenfatik drenaj ve erken evrelerde belirgin semptom vermemeleri sebebiyle genellikle ileri evrelerde teşhis edilmekte ve baş-boyun kanserleri arasında en kötü prognoza sahip olmaktadır. Erken evrelerde radyoterapi veya konservatif cerrahi tercih edilirken, ileri evrelerde total/parsiyel laringofarenjektomi, boyun diseksiyonu ve kemoradyoterapiyi içeren kombine tedaviler ile organ koruma protokolleri uygulanmaktadır. Tedavinin temel amacı, hastalığı ortadan kaldırırken fonksiyonları korumaktır.
The hypopharynx and cervical esophagus carry immense clinical significance due to their complex anatomy and critical roles in physiological functions such as swallowing and speech. Although diseases affecting these regions are rare, they represent major sources of morbidity and mortality, necessitating a comprehensive, multidisciplinary management approach. This chapter reviews both neoplastic and non-neoplastic disorders in light of current medical literature. Non-neoplastic conditions discussed include foreign bodies, cricopharyngeal dysphagia, Plummer-Vinson syndrome, laryngopharyngeal reflux, and various pharyngoesophageal diverticula, most notably Zenker's diverticulum originating from Killian's triangle. Neoplastic diseases focus on cervical esophageal cancer and hypopharyngeal cancer, the latter being predominantly squamous cell carcinoma. Due to rich lymphatic drainage and an absence of early symptoms, these malignancies are frequently diagnosed at advanced stages, resulting in the poorest prognosis among all mucosal head and neck cancers. While early-stage tumors are managed with radiotherapy or conservative surgery, advanced cases require aggressive interventions including total or partial laryngopharyngectomy, selective neck dissection, and chemoradiotherapy, alongside organ-preservation protocols. The primary goal remains eliminating the disease while successfully preserving vital physiological functions.
Referanslar
Wang ZM, Zhang SC, Teng X. Esophageal diverticulum serves as a unique cause of bronchoesophageal fistula in children: A case report. Medicine (Baltimore). 2017;96(51):e9492.
Yam J, Baldwin D, Ahmad SA. Esophageal Diverticula. StatPearls. Treasure Island (FL)2021.
Maselli R, Spadaccini M, Cappello A, et al. Flexible endoscopic treatment for Zenker's diverticulum: from the lumen to the third space. Ann Gastroenterol. 2021;34(2):149-154.
Tabola R, Lewandowski A, Cirocchi R, et al. Zenker diverticulum: Experience in surgical treatment of large diverticula. Medicine (Baltimore). 2018;97(19):e0557.
Little RE, Bock JM. Pharyngoesophageal diverticuli: diagnosis, incidence and management. Curr Opin Otolaryngol Head Neck Surg. 2016;24(6):500-504.
Weusten B, Barret M, Bredenoord AJ, et al. Endoscopic management of gastrointestinal motility disorders - part 2: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020;52(7):600-614.
Özgürsoy O. Faringeal Yutma Bozuklukları. In: Önerci T, editor. Kulak Burun Boğaz Baş Boyun Cerrahisi. Ankara: Güneş Tıp Kitabevleri; 2021. p. 565-570.
Ujiie N, Taniyama Y, Sato C, et al. Surgical Intervention for Laimer's Diverticulum, a Rare Type of Pharyngoesophageal Diverticulum: A Case Report. OTO Open. 2019;3(2):2473974X19847670.
Adams KM, Mahin KE. Killian-Jamieson Diverticulum. J Am Osteopath Assoc. 2015;115(11):688.
Tagliaferri A. The role of fluoroscopy in diagnosing a Killian-Jamieson diverticulum. J Community Hosp Intern Med Perspect. 2021;11(2):228-234.
Boisvert RD, Bethune DC, Acton D, et al. Bilateral Killian-Jamieson diverticula: a case report and literature review. Can J Gastroenterol. 2010;24(3):173-174.
Naunheim M, Langerman A. Pharyngoceles: a photo-anatomic study and novel management. The Laryngoscope. 2013;123(7):1632-1638.
Yilmaz T, Cabbarzade C, Suslu N, et al. Novel endoscopic treatment of pharyngocele: endoscopic suture pharyngoplasty. Head Neck. 2014;36(8):E78-80.
Kim SY, Park B, Kong IG, et al. Analysis of ingested foreign bodies according to age, type and location: a retrospective observational study. Clin Otolaryngol. 2016;41(6):640-645.
Murono S, Tsuji A, Endo K, et al. Evaluation of modified Killian's method: a technique to expose the hypopharyngeal space. The Laryngoscope. 2014;124(11):2526-2530.
Castan Senar A, Dinu LE, Artigas JM, et al. Foreign Bodies on Lateral Neck Radiographs in Adults: Imaging Findings and Common Pitfalls. Radiographics. 2017;37(1):323-345.
Dewan K, Santa Maria C, Noel J. Cricopharyngeal Achalasia: Management and Associated Outcomes-A Scoping Review. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2020;163(6):1109-1113.
Verma S, Mukherjee S. Plummer Vinson Syndrome. StatPearls. Treasure Island (FL)2021.
Bruss DM, Sajjad H. Anatomy, Head and Neck, Laryngopharynx. StatPearls. Treasure Island (FL)2021.
Morrison MD. Is chronic gastroesophageal reflux a causative factor in glottic carcinoma? Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 1988;99(4):370-373.
Reavis KM, Morris CD, Gopal DV, et al. Laryngopharyngeal reflux symptoms better predict the presence of esophageal adenocarcinoma than typical gastroesophageal reflux symptoms. Ann Surg. 2004;239(6):849-856; discussion 856-848.
Swoger J, Ponsky J, Hicks DM, et al. Surgical fundoplication in laryngopharyngeal reflux unresponsive to aggressive acid suppression: a controlled study. Clin Gastroenterol Hepatol. 2006;4(4):433-441.
Kwon DI, Miles BA, Education Committee of the American H, et al. Hypopharyngeal carcinoma: Do you know your guidelines? Head Neck. 2019;41(3):569-576.
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2018;68(6):394-424.
Combes JD, Franceschi S. Role of human papillomavirus in non-oropharyngeal head and neck cancers. Oral oncology. 2014;50(5):370-379.
Krstevska V. Early stage squamous cell carcinoma of the pyriform sinus: a review of treatment options. Indian journal of cancer. 2012;49(2):236-244.
Sanders O, Pathak S. Hypopharyngeal Cancer. StatPearls. Treasure Island (FL)2021.
Kuo P, Sosa JA, Burtness BA, et al. Treatment trends and survival effects of chemotherapy for hypopharyngeal cancer: Analysis of the National Cancer Data Base. Cancer. 2016;122(12):1853-1860.
Takes RP, Strojan P, Silver CE, et al. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head Neck. 2012;34(2):270-281.
Forastiere AA, Ismaila N, Lewin JS, et al. Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2018;36(11):1143-1169.
Amin MB, Edge, S., Greene, F., et al, eds. AJCC Cancer Staging Manual. 8th ed. New York: Springer; 2017.
Echanique KA, Evans LK, Han AY, et al. Cancer of the Larynx and Hypopharynx. Hematol Oncol Clin North Am. 2021;35(5):933-947.
Simard EP, Torre LA, Jemal A. International trends in head and neck cancer incidence rates: differences by country, sex and anatomic site. Oral oncology. 2014;50(5):387-403.
Kuo P, Chen MM, Decker RH, et al. Hypopharyngeal cancer incidence, treatment, and survival: temporal trends in the United States. The Laryngoscope. 2014;124(9):2064-2069.
Liu J, Zhu W, Li Z, et al. Proteomic analysis of hypopharyngeal and laryngeal squamous cell carcinoma sheds light on differences in survival. Sci Rep. 2020;10(1):19459.
Ilson DH. New developments in the treatment of esophageal cancer. Curr Oncol Rep. 2002;4(3):213-221.
Lee DJ, Harris A, Gillette A, et al. Carcinoma of the cervical esophagus: diagnosis, management, and results. South Med J. 1984;77(11):1365-1367.
Martins AS. Neck and mediastinal node dissection in pharyngolaryngoesophageal tumors. Head Neck. 2001;23(9):772-779.
Daiko H, Hayashi R, Sakuraba M, et al. A pilot study of post-operative radiotherapy with concurrent chemotherapy for high-risk squamous cell carcinoma of the cervical esophagus. Jpn J Clin Oncol. 2011;41(4):508-513.
Zhang P, Xi M, Zhao L, et al. Clinical efficacy and failure pattern in patients with cervical esophageal cancer treated with definitive chemoradiotherapy. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2015;116(2):257-261.
Huang SH, Lockwood G, Brierley J, et al. Effect of concurrent high-dose cisplatin chemotherapy and conformal radiotherapy on cervical esophageal cancer survival. International journal of radiation oncology, biology, physics. 2008;71(3):735-740.
