Velopharyngeal Function After Microsurgical Reconstruction of Lateral and Superior Oropharyngeal Defects†‡
Presented in part at the 43rd Annual Meeting of the Japanese Society of Plastic and Reconstructive Surgery, Sapporo, Japan, May 24, 2000, and at the 24th Annual Meeting of the Japanese Society for Head and Neck Cancer, Tokyo, Japan, June 15, 2000.
Supported by a Grant-in-Aid for Cancer Research (grant 9-17) from the Ministry of Health and Welfare of Japan.
Abstract
Objectives/Hypothesis Defects of the lateral and superior oropharyngeal wall are difficult to reconstruct because of their complicated anatomy and the possibility of causing velopharyngeal incompetence. The objective was to investigate problems of reconstruction and postoperative velopharyngeal function.
Study Design Defects were classified into three types (I, II, and III) according to their extent. Four operative procedures were performed: the Patch, Jump, Denude, and Gehanno methods, which include a lateral–posterior pharyngeal advancement flap. Speech intelligibility, velopharyngeal function, and wound dehiscence between the flap and the remaining soft palate were evaluated.
Methods Forty patients who had undergone resection of the lateral and superior oropharyngeal walls and subsequent reconstruction were reviewed.
Results Most patients with type I or II defects had satisfactory velopharyngeal function. However, in patients with type III defects, speech function was worse and severe velopharyngeal incompetence was more common. The type of defect and the presence of wound dehiscence were related to postoperative function. The rates of wound dehiscence were lower with the Patch and Gehanno methods.
Conclusions Postoperative function in patients with type III defects can be affected by various factors. We suggest that the Gehanno method be the treatment of choice for reconstruction of extensive defects of the oropharynx. However, patients in whom more than two-thirds of the superior and posterior oropharyngeal walls has been resected are poor candidates for reconstruction because of the difficulty of maintaining both nasal airway patency and velopharyngeal function.
