Extended surgery for advanced oropharyngeal carcinoma (stage III, stage IV UICC 1987) originating from the lateral wall was performed in 13 patients from 1992 to 1995 using the mandibular swing technique. Histopathologic findings were squamous cell carcinoma in all cases. The primary lesions were T2 in one case, T3 in 6 cases, T4 in 6 cases. The surgical margin of the deep layer was composed of the styloid process, carotid sheath and medial side of the mandibula. En bloc resection encompassing the primary region, dissected neck tissue, internal pterygoid muscle and parapharyngeal tissue was performed. In those cases where the tumor had invaded the mandibula, a marginal or a segmental resection was carried out.
Reconstruction of the oropharynx was performed with only a forearm flap in 7 cases, and a pectoralis major musculocutaneous flap in 2 cases. Reconstruction with a forearm flap combined with a pectoralis major muscular flap was needed for obliteration of parapharyngeal and submandibular dead space in 3 cases. Reconstruction of mandibula was performed with a fibular osteocutaneous flap in 1 case.
Postoperative complications, included open rhinolalia in 4 cases, dysphagia in 5 cases, and difficulty opening the mouth in 5 cases. Local recurrence was noted in 2 cases, 13 and 10 months after surgery, respectively. The tumor recurred in the region from the anterior arch of the palate to the retromolar area in both cases. Tumors invading this region should be resected with careful determination of the resected area.
