Analysis of Compensatory Function after Wide Resection and Reconstruction in Oropharyngeal Cancer

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  • Chitose Shunichi
    Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine
  • Hamakawa Sachiyo
    Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine
  • Maeda Akiteru
    Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine
  • Umeno Hirohito
    Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine
  • Nakashima Tadashi
    Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine

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  • 中咽頭癌切除再建術後の機能代償に関する研究
  • チュウイントウ ガン セツジョ サイケン ジュツゴ ノ キノウ ダイショウ ニ カンスル ケンキュウ

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Abstract

When wide resection and reconstruction for advanced oropharyngeal cancer are performed, we often experience many functional disorders postoperatively; and, in particular, postoperative dysphagia frequently causes tragic results. In this study, we quantitatively analyzed compensatory function after reconstructive surgery for advanced oropharyngeal cancer. Analyses were performed in 52 patients who received radical resection of oropharyngeal cancers with laryngeal preservation and without preoperative radiotherapy. Using lateral views of videofluorography, the anterior bulge of the posterior pharyngeal wall (PPW) at two time points, in rest status and pharyngeal swallow, was measured and calculated as the ratio of PPW movement. These measured values were compared with those of control cases, and were divided into three categories according to over/under 60 years of age, method of reconstruction and presence/absence of nasopharyngeal closure (NC). The mean ratio of PPW movement in the postoperative cases was higher than in the control cases at 3 and 6 months after surgery. There was no significant difference between age categories. Regarding methods of reconstruction, the mean ratio of PPW movement in the pectoralis major myocutaneous flap group was significantly higher than in the free rectus abdominus muscle flap group at 3 and 6 months after surgery. In the comparison of NC, the mean ratio of PPW movement in the NC positive group was significantly higher than in the NC negative group at 6 months after surgery. These results indicate potential for postoperative compensatory function in left oropharyngeal tissues when the contraction in the resected parts becomes weak, and also suggest more remarkable compensatory potential from 3 months after surgery.

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