Reconstruction after wide resection of soft palate and lateral pharyngeal wall in oropharyngeal cancer patients.

FUJII Takashi, SATO Takeo, YOSHINO Kunitoshi, INAKAMI Ken-ichi, NAGAHARA Masamitsu, MOMOHARA Chikahiro, TERADA Tomonori, NISHIMOTO Soh

doi:10.5981/jjhnc1974.25.94

Velopharyngeal dysfunction is one of the most serious morbidities after wide resection of the soft palate and lateral oropharyngeal wall in patients with carcinoma of the oropharynx. For minimizing the dysfunction, oropharyngeal reconstruction using a vascularized free flap in combination with a pharyngeal flap was performed in seven patients with squamous cell carcinomas originating from the lateral oropharyngeal wall, requiring resecting more than half of the soft palate besides the lateral wall.<br>The reconstructive procedure was as follows: The lateral pharyngeal flap was elevated in the resection margin of the posterior pharyngeal wall on the prevertebral fascia. It was mobilized enough and sutured without excessive tension to the nasopharyngeal surface in the remaining soft palate and the posterior edge of the hard palate. As a result the nasopharyngeal surface of the soft palate was entirely covered by mucosa and reconstructed in a funnel shape. The resection defect in the oral cavity, the oropharynx and the parapharyngeal space were covered with a vascularized free flap; rectus abdominis musculocutaneous flap in six patients and radial forearm flap in one.<br>Postoperative speech audibility according to the questionnaire was excellent in all patients, and their articulation test scores, pronunciation of 100 Japanese monosylables, were high, between 62% and 94%. All but two (with poor dental conditions) patients could take solid food. According to the questionnaire: nasal obstruction was not experienced at all; aspiration was “rare” in three patients and “none” in four, and nasal regurgitation was “rare” in two, and “none” in five. Endoscopic findings showed that the funnel-shaped narrowing velopharyngeal port was closed completely on swallowing due to the movement of the remaining soft palate and the lateral pharyngeal wall on the intact side.

Reconstruction after wide resection of soft palate and lateral pharyngeal wall in oropharyngeal cancer patients.

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