Velopharyngeal function after microsurgical reconstruction of lateral and superior oropharyngeal defects.
OBJECTIVE
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.


METHODS
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.
Kimata
Yoshihiro
Y
Division of Plastic and Reconstructive Surgery and Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. ykimata@east.ncc.go.jp
Uchiyama
Kiyotaka
K
Sakuraba
Minoru
M
Ebihara
Satoshi
S
Hayashi
Ryuichi
R
Haneda
Tatsumasa
T
Onitsuka
Testuro
T
Asakage
Takahiro
T
Nakatsuka
Takashi
T
Harii
Kiyonori
K
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009960:Oropharynx / Q000601:surgery*; D010160:Palate, Soft / Q000503:physiopathology*; D010614:Pharynx / Q000503:physiopathology*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D013060:Speech; D013529:Surgical Wound Dehiscence; D014681:Velopharyngeal Insufficiency / Q000209:etiology