Abstract
Reconstruction of the surgical defect of the superior and lateral oropharyngeal walls is complicated and frequently results in velopharyngeal dysfunction. In this paper, a simple and reliable reconstructive method of the superior and lateral oropharyngeal walls is described and postoperative function of the patients who underwent reconstruction is evaluated.
The superior oropharyngeal wall is reconstructed by developing a plane between the prevertebral fascia and superior pharyngeal constrictor in the oropharyngeal resection margin. The pharyngeal myomucosal flap is mobilized and sutured to the posterior edge of the hard palate and remaining soft palate, resulting in reconstruction of a smaller velopharyngeal space. Then the faucial arch is narrowed by suturing the edge of the posterior pharyngeal wall to the tongue base. Finally, the exposed muscle of the pharyngeal constrictor and other ablative defects are covered with a flap.
During the past 17 years, this reconstructive procedure was performed on 21 patients with carcinoma of the oral cavity or oropharynx. All of these patients had the surgical defect of a half to two-thirds of the soft palate combined with the lateral oropharyngeal wall.
After reconstruction, 20 patients had a normal nasal airway. Slight nasal regurgitation of liquids with swallowing developed in 6 patients and aspiration developed in 3 patients. Postoperative articulatory dysfunction resulting from velopharyngeal insufficiency was within the acceptable range. The postoperative function in patients of the forearm flap reconstruction group was superior to that of the myocutaneous flap reconstruction group.
This reconstructive procedure is easy to carry out and preserves the important function of the oropharynx.
