Hypopharyngeal pharyngoplasty procedure in the rehabilitation of swallow in patients with vagal paralysis

Pharyngeal paralysis in patients with high vagal paralysis (HVP) is a problem that can be devastating. The hypopharyngeal pharyngoplasty procedure is an adjunctive static procedure designed to address some of the difficulties with swallow seen in these patients. The procedure can be used acutely in patients with HVP to avoid gastrostomy tube dependence, or it can be done late in patients with persistent dysphagia. The purpose of this article is to delineate the indications for this procedure and the technical aspects of performing the procedure. The procedure partially corrects the aspiration and dysphagia in patients after HVP by reshaping the hypopharyngeal anatomy to promote better bolus transit, thereby improving cervical dysphagia. Because it is a static procedure, its indications in patients with complex swallow dysfunction should be well understood in consideration of the many other surgeries that have been proposed in patients with swallow dysfunction.