title: Reconstructive algorithm and classification system for transoral oropharyngeal defects.
abstract: BACKGROUND
  Transoral techniques for oropharyngeal tumors, such as transoral robotic surgery (TORS) and transoral laser microsurgery, require new reconstructive considerations.
  
  
  METHODS
  Defects from 92 patients undergoing TORS were classified into 4 classes. A reconstruction algorithm was followed. Perioperative outcomes and complications were assessed. Forty-seven patients completed the MD Anderson Dysphagia Inventory (MDADI) swallowing questionnaire and a modified Velopharyngeal Insufficiency Quality of Life (VPIQL) questionnaire postoperatively.
  
  
  RESULTS
  The most common reconstructions involved velopharyngoplasties with local flaps (39%), local flaps alone (25%), or secondary healing (20%). More advanced defects (class III and IV defects) required regional and free flaps more often. No significant differences were found in MDADI scores or VPIQL scores among the 4 defect classes. Only adjuvant radiotherapy was a predictor of poor swallowing (p = .02).
  
  
  CONCLUSIONS
  The classification system for transoral oropharyngeal defects maps defects into 4 classes and guides the reconstructive thought process.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York.
authors.forename: John R
authors.initials: JR
authors.lastname: de Almeida
authors.forename: Richard Chan Woo
authors.initials: RC
authors.lastname: Park
authors.forename: Nathaniel L
authors.initials: NL
authors.lastname: Villanueva
authors.forename: Brett A
authors.initials: BA
authors.lastname: Miles
authors.forename: Marita S
authors.initials: MS
authors.lastname: Teng
authors.forename: Eric M
authors.initials: EM
authors.lastname: Genden
mesh_terms: D000465:Algorithms; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D017577:Cutaneous Fistula / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D005774:Gastrostomy; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D065287:Robotic Surgical Procedures; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D014139:Tracheostomy; D014681:Velopharyngeal Insufficiency / Q000209:etiology
keywords: classification system; complications; functional outcomes; perioperative outcomes; reconstruction; reconstructive algorithm; transoral laser microsurgery; transoral oropharyngeal surgery; transoral robotic surgery