Refinement of the free radial forearm flap reconstructive technique after resection of large oropharyngeal malignancies with excellent functional results.
BACKGROUND
Wide resection of oropharyngeal malignancies implicates the risk of velopharyngeal insufficiency, which can cause nasal regurgitation and hypernasality. A meticulous reconstruction is necessary to avoid impairment and handicap in deglutition and speech. In the classic reconstructive techniques for large oropharyngeal defects, functional outcome only regards deglutition. We also focus on nasality, because hypernasality often occurs as a consequence in this type of reconstruction.


METHODS
In four patients, the surgical defect is closed with a free radial forearm flap sutured to the posterior side of the hard palate, thus imitating a caudally based pharyngeal flap. Speech is assessed by an independent speech pathologist, perceptually and acoustically. Deglutition is evaluated by a questionnaire and videofluoroscopy.


RESULTS
All patients had normal food intake. They did not report alterations in speech quality or verbal communication. Perceptual evaluation of articulation, voice, and nasality was optimal. Objective measurements with acoustical analysis and nasality scores confirmed the excellent functional outcome. Videofluoroscopy showed an unimpaired bolus transport with a complete velopharyngeal closure and optimal oral and pharyngeal clearance times.


CONCLUSIONS
This meticulous reconstructive technique ensures an excellent functional outcome. The absence of nasality, in particular, proves the value of this refinement. The technique allows wide surgical margins and complete velopharyngeal closure.
Moerman
Mieke
M
Department of Otorhinolaryngology, Head and Neck Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. mieke.moerman@rug.ac.be
Vermeersch
Hubert
H
Van Lierde
Kristiane
K
Fahimi
Hossein
H
Van Cauwenberge
Paul
P
D003679:Deglutition; D005260:Female; D006801:Humans; D008297:Male; D009959:Oropharyngeal Neoplasms / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D010865:Pilot Projects; D013065:Speech Intelligibility; D013524:Surgical Flaps; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*