Oropharyngoplasty with template-based reconstruction of oropharynx defects.
OBJECTIVE
To determine if oropharyngoplasty using a Gehanno technique of superior constrictor velopharyngoplasty, base of tongue mounding, and primary hypopharyngeal closure in combination with template-based revascularized free tissue transfer is effective for reconstruction of the oropharyngeal defect.


METHODS
Prospective case series.


METHODS
Tertiary care academic medical center.


METHODS
The study population comprised 25 patients (21 men and 4 women; mean age, 55.3 years) presenting from January 1998 to January 2001 with oropharyngeal squamous cell carcinoma. A comparison was performed based on the percentage of resection of the soft palate (group 1, < or =50% palate; group 2, >50% palate).


METHODS
Of the 25 patients, 24 (96%) received radiotherapy. The donor sites were radial forearm for 23 of 25 patients (92%) and lateral arm for 2 of 25 patients (8%). The mean area was 92 cm(2) (range, 25-150 cm(2)), and the mean length of the velopharyngoplasty component of the oropharyngoplasty was 2.15 cm (range, 1-3 cm).


METHODS
Gastrostomy tube dependence, major and minor complications, time to oral intake, speech and swallowing assessment, and quality-of-life assessment.


RESULTS
Of the 25 patients, 2 (8%) remain gastrostomy dependent; 6 (24%) developed major complications; and 7 (28%) developed minor complications. Speech in both groups 1 and 2 was considered understandable most of the time, with occasional repetition. The group 1 patient with a median assessment score could eat a solid diet without restriction of place or person, whereas the group 2 patient with a median assessment score could eat a soft, moist diet with selected persons in selected places.


CONCLUSIONS
Integration of oropharyngoplasty with template-based revascularized free tissue transfer produced speech results that were independent of palate defect size, and swallow function test results were similar to other published reconstructive techniques.
Chepeha
Douglas B
DB
Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, 1904 Taubman Center, Ann Arbor, MI 48109-0312, USA. dchepeha@umich.edu
Sacco
Assuntina G
AG
Erickson
Vanessa R
VR
Lyden
Teresa
T
Haxer
Marc
M
Moyer
Jeffrey
J
Teknos
Theodoros N
TN
Prince
Mark E
ME
Eisbruch
Avraham
A
Bradford
Carol R
CR
Wolf
Gregory T
GT
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011336:Probability; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013524:Surgical Flaps / Q000098:blood supply*; D016019:Survival Analysis; D016896:Treatment Outcome