Browse > Article

Reconstruction of Velopharyngeal Function after Resection of Lateral and Superior Oropharyngeal Cancer  

Lee, Hyoung Gyo (Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University)
Tark, Min Soong (Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University)
Kim, Cheol Hann (Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University)
Shin, Ho Sung (Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University)
Kang, Sang Gue (Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University)
Lee, Young Man (Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University)
Publication Information
Archives of Plastic Surgery / v.33, no.5, 2006 , pp. 546-551 More about this Journal
Abstract
Purpose: The reconstruction of oropharyngeal defect after cancer surgery is very difficult because of their complicated structure and the functional importance to prevent velopharyngeal incompetence. In this article we investigated affecting factors of velopharyngeal function after reconstruction and a fundamental rule of reconstruction for saving their functions such as swallowing, speeching and breathing. Methods: We classified 18 patients into three group under Kimata's grouping. Type I defect(6 patients) was healed by primary closure or secondary intention. In Type II or III defect, two operation methods were used - the folded flap(8 patients) and modified Gehanno method(4 patients), which include a lateral-posterior pharyngeal rotation-advancement flap. We evaluated wound dehiscence between the flap and the soft palate, speech intelligibility using Hirose's method, regurgitation during oral feeding, and hypernasality. Results: Most of type I or II defects patients recovered satisfactory velopharyngeal function. But, in patients with type III defects we found wound dehiscence, worse speech function, and common velopharyngeal incompetence. Conclusion: The large defect size and presence of wound dehiscence are major factors of postoperative velopharyngeal function. We conclude that folded flap or modified Gehanno method is a good reconstructive operation method for broad contact between the flap and defect site, preventing wound problem.
Keywords
Velopharyngeal incompetence; Lateral and superior oropharyngeal defect;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Gehanno P, Guedon C Veber F, Perreau P, Alalouf P, Moisy N: Velopharyngeal rehabilitation after transmaxillary buccopharyngectomy extending to the soft palate. Ann Otolaryngol Chir Cervicofac 102: 135, 1985
2 Shin YJ: A clinical application of scapular free flap in intraoral and oropharyngeal defect reconstruction. J Korean Soc Plast Reconstr Surg 22: 312, 1995
3 Penfold CN, Brown AE, Lavery KM, Venn PJ: Combined radial forearm and pharyngeal flap for soft palate reconstruction. Br J Oral Maxillofac Surg 34: 322, 1996
4 Shapiro BM, Komisar A, Silver C, Strauch B: Primary reconstruction of palatal defects. Otolaryngol Head Neck Surg 95: 581, 1986
5 Koh YW, Choi HS, Lew DH, Pyo HY, Choi EC: Postoperative assessment of articulation and velopharyngeal functions in oropharyngeal cancer. Korean J Otolaryngol 48: 1491, 2005
6 Yoshida H, Michi K, Yamashita Y, Ohno K: A comparison of surgical and prosthetic treatment for speech disorders attributable to surgically acquired soft palate defects. J Oral Maxillofac Surg 51: 361, 1993
7 Kimata Y, Uchiyama K, Sakuraba M, Ebihara S, Hayashi R, Haneda T, Onitsuka T, Asakage T, Nakatsuka T, Harii K: Velopharyngeal function after microsurgical reconstruction of lateral and superior oropharyngeal defects. Laryngoscope 112: 1037, 2002   DOI   ScienceOn
8 Eun SC, Chung CH, Oh SJ, Burm JS, Kim JB: Functional evaluation of oral and oropharyngeal reconstruction using radial forearm free flap. J Korean Soc Plast Reconstr Surg 27: 303, 2000
9 Brown JS, Zuydam AC, Jones DC, Rogers SN, Vaughan ED: Functional outcome in soft palate reconstruction using a radial forearm free flap in conjunction with a superiorly based pharyngeal flap. Head Neck 19: 524, 1997
10 Hashikawa K, Tahara S, Terashi H, Ichinose A, Nomura T, Omori M, Sanno T: Positive narrowing pharyngoplasty with forearm flap for functional restoration after extensive soft palate resection. Plast Reconstr Surg 115: 388, 2005   DOI   ScienceOn
11 Kavanagh KT, Hinkle We: Reconstruction of the soft palate after jaw, tongue, neck dissection with subtotal palatectomy(velopharyngoplasty). Laryngoscope 97: 1461, 1987