A Review of and Algorithmic Approach to Soft Palate Reconstruction

Abstract

IMPORTANCEThe soft palate contributes to deglutition, articulation, and respiration. Current reconstructive techniques focus on restoration of both form and function. The unique challenges of soft palate reconstruction include maintenance of complex upper aerodigestive tract function, with minimal local or donor site morbidity.OBJECTIVE To review the literature on soft palate reconstruction and present an algorithm on how to approach soft palate defects based on this review.EVIDENCE REVIEW A review of the literature for articles reporting studies on and that described concepts related to soft palate reconstruction was conducted in March 2017. In all, 1804 candidate titles and abstracts were independently reviewed. English-language articles that discussed acquired soft palate defect reconstruction were included. Non-English language studies without available translations, studies on primary soft palate defect reconstruction (ie, cleft palate repair) and primary cleft palate repair, studies in which the soft palate was not the focus of the article, and studies involving animals were excluded.FINDINGS The following observations were made from the review of 92 included articles. Soft palate anatomy is a complex interplay of multiple structures working in a 3-dimensional area. Three of the authors created an initial algorithmic framework based on the selected studies. After this, a round table discussion among 3 authors considered experts was used to refine the algorithm based on their expert opinion. The 4 most important factors were determined to be defect size, defect extension to other subsites, defect thickness, and history of radiotherapy or planned radiotherapy. This algorithm includes both surgical and nonsurgical options. Defects in the soft palate not only affect the size and shape of the organ but, more critically, the function. The reconstructive ladder is used to help maximize the remaining soft palate functional tissue and minimize the effect of nonfunctional implanted tissue. Partial-thickness defects or defects less than one-fourth of the soft palate may not require locoregional tissue transfer. Patients with a history of radiotherapy or defects of up to 75% of the soft palate may require locoregional tissue transfer. Defects greater than 75% of the soft palate, defects that include exposure of the neck vasculature, or defects that include significant portions of the hard palate or adjacent oropharyngeal subsites may require free tissue transfer. Obturation should be considered a second-line option in most cases.CONCLUSIONS AND RELEVANCE Ideal reconstruction of the soft palate relies on a comprehensive understanding of soft palate anatomy, a full consideration of the armamentarium of surgical techniques, consideration for adjacent subsite deficits, and a detailed knowledge of various intrinsic and extrinsic patient factors to optimize speech, swallowing, and airway outcomes. The included algorithm may serve as a useful starting point for the surgeon when considering reconstruction.

Free flap for soft palate reconstruction: long-term functional evaluation of a new technique

“…Our treatment strategy meets most of the author's recommendations [1,2]. We perform local flaps for minor defects and limit obturators to fragile patients or those who refuse a new surgery.…”

“…Nowadays, there are many surgical techniques. Some authors tried to establish a management standardization [ 1 , 2 ] based on the expected defect size, but the precise surgical protocol remains depending on the surgeon’s habits and the patient’s preferences.…”

“…While keeping an optimal preservation of cancer surveillance, it has to reproduce the soft palate and its velopharyngeal sphincter functions. [ 1 , 2 ].…”

Soft palate resection and secondary healing not to impair the velopharyngeal function? – Diagnosis and treatment of an intraoral schwannoma: A case report

“…The soft palate contributes to deglutition, articulation, and respiration. Reconstruction strategies aim to restore form and function [ 12 ]. To reconstruct defects of the soft palate, different strategies are mentioned and described in the literature and should address the rehabilitation of functional aspects concerning speech, swallowing and airway.…”

“…Even though knowing different strategies closing a soft palate defect [ 12 ], we decided to await secondary healing not to affect the velopharyngeal function. Our follow up eight weeks following Re-resection ( Fig.…”