Facial artery musculomucosal flaps in oropharyngeal reconstruction following salvage transoral robotic surgery: a review of outcomes

Asairinachan, Ashwinna; O’Duffy, Fergal; Li, M P; Fua, Tsien; Chauhan, Abha; Magarey, Matthew; Dixon, Benjamin J.

doi:10.1017/s002221511900183x

Cited by 9 publications

(7 citation statements)

References 29 publications

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“…Of these, 51 articles were reviewed in full following screening and removal of duplicates. A total of 26 final studies met inclusion based on appropriateness of patient population, intervention performed, and outcome of interest adequately specified 15–40 . One study detailing reconstructive strategies of TORS defects was excluded due to lack of description regarding specific reconstructive modalities used in the patient cohort described 11 .…”

Section: Resultsmentioning

confidence: 99%

“…Such complications include exposure of vital structures, infection, delayed healing, and necrosis; introduction of healthy and well-vascularized tissue into these fields helps to minimize such morbidity and promotes positive functional outcomes. [9][10][11] The goals of oropharyngeal reconstruction are to provide adequate coverage of defects and associated structures while maintaining function, including velopharyngeal competence and swallowing. 10 In order to preserve the critical functions of the upper aerodigestive tract, careful consideration of all reconstructive options is required after TORS.…”

Section: Introductionmentioning

confidence: 99%

“…Though many resection sites may be closed primarily or allowed to heal by secondary intention, larger defect size, adjuvant radiation and chemotherapy, and other factors may impair healing and lead to significant complications. Such complications include exposure of vital structures, infection, delayed healing, and necrosis; introduction of healthy and well‐vascularized tissue into these fields helps to minimize such morbidity and promotes positive functional outcomes 9–11 . The goals of oropharyngeal reconstruction are to provide adequate coverage of defects and associated structures while maintaining function, including velopharyngeal competence and swallowing 10 .…”

Section: Introductionmentioning

confidence: 99%

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Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

et al. 2022

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We performed a systematic review to characterize reconstructive modalities and postoperative surgical outcomes following TORS resection. A search of the PubMed, SCOPUS, and EMBASE databases was conducted to identify studies describing patients undergoing reconstruction of TORS defects. Twenty‐six studies met inclusion criteria, consisting of 260 patients who underwent TORS resection followed by reconstruction. Twenty‐one studies reported tumor classification information, with TORS performed for 44 (23.0%) T1, 86 (45.0%) T2, 33 (17.3%) T3, and 28 (14.7%) T4 tumors. Eighteen distinct reconstructive modalities were described in the studies identified, including nine unique free flap types. The most commonly performed reconstruction was the radial forearm free flap (RFFF), accounting for 121/260 (46.5%) of reconstructions performed. Reported surgical complications included 5 pharyngocutaneous fistulae, 13 hemorrhagic complications, 24 infectious complications, and 5 free flap failures. Our findings demonstrate favorable surgical outcomes but minimal quantitative functional data to compare reconstructive options following TORS.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

et al. 2022

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“…Flap reconstruction is a feasible alternative when a wide resection is needed to treat an oropharyngeal stenosis. Local flaps, such as buccal mucosal or facial artery musculomucosal flap, are the first available options in case of small-to-moderate-sized defects [ 21 – 24 ]. Larger defects require regional myocutaneous pedicled flaps or microvascular tissue transfer, which are all excellent options for wide oropharyngeal and hypopharyngeal reconstruction.…”

Section: Discussionmentioning

confidence: 99%

A Rare Presentation of Recalcitrant Oropharyngeal Stenosis in a 54-Year-Old Male Patient Following Transoral Robotic Surgery for Obstructive Sleep Apnea

et al. 2022

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Patient: Male, 54-year-old Final Diagnosis: Oropharyngeal stenosis Symptoms: Dysphagia • dyspnoea Medication: — Clinical Procedure: — Specialty: Otolaryngology Objective: Unusual or unexpected effect of treatment Background: Transoral robotic surgery (TORS) is an effective and safe option for obstructive sleep apnea syndrome (OSAS) patients with isolated retrolingual obstruction, as well as part of multilevel surgical approach in case of multilevel obstruction. Stenosis after TORS in OSAS patients is rarely described and no literature review has investigated this dramatic untoward event. Case Report: We report on a case of severe recalcitrant oropharyngeal stenosis after multilevel surgery with transoral robotic tongue base resection in an OSAS patient, leading to tracheotomy and gastrostomy dependence. Following the failure of numerous conservative therapeutic attempts, oropharyngeal patency was restored after extensive scar tissue removal through an open-neck approach, followed by a pharyngeal reconstruction with radial forearm free flap (RFFF). Conclusions: Recalcitrant oropharyngeal stenosis is a dramatic complication that must be considered in OSAS patients submitted to TORS in a multilevel strategy and that is rarely described in the literature. A thorough review of the existing literature is presented to assess which factors are involved and the therapeutic strategies invoked in this scenario. The adoption of resection tools suited for robot-assisted surgery and the staging of TORS in case of multilevel surgery could decrease the risk of extensive scar formation. To date there is still no broad consensus on which therapeutic choice is the best for recalcitrant oropharyngeal stenosis. When minimally invasive treatments fail, a wide scar resection with a RFFF oropharyngeal reconstruction could be considered as a valuable option to restore the upper aerodigestive tract patency.

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“…The FAMM flap is commonly used for these indications and preferred for its large axis of rotation with ability to reach multiple areas within the oropharynx [36]. In a series of 13 patients undergoing salvage TORS for pT1–4 OPSCC reconstructed with the FAMM flap, all cases were successful without delayed wound healing, flap necrosis, or velopharyngeal insufficiency (VPI) [37 ▪ ]. Similar results were shown by Bonawitz et al [38] who reported flap success in all reconstructions which included four ipsilateral and one bilateral FAMM flaps.…”

Section: Recent Findingsmentioning

confidence: 99%

Oropharyngeal reconstruction after transoral robotic surgery

Silverman

Birkeland

Bewley

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewTransoral robotic surgery (TORS) has experienced an evolution in recent years. This technique has proved to be a safe and effective method for extirpation of select oropharyngeal tumors. Advances in technology as well as improved surgeon experience allow for the resection of larger, more complex cancers. Although healing by secondary intention remains the current standard for limited oropharyngeal defects, larger resections demand reconstruction with vascularized tissue to minimize morbidity and optimize functional outcomes. The objective of this review is to evaluate recent literature regarding oropharyngeal reconstruction after TORS. Recent findingsA variety of reconstructive options to manage oropharyngeal defects exist. Several reconstructive algorithms have been suggested; however, careful consideration must be used to select the most ideal flap type. Locoregional flaps have shown excellent functional outcomes with limited morbidity. An increase in free flap reconstruction has been demonstrated, particularly among patients with larger TORS defects and following chemoradiation therapy. Despite limited data, robotic-assisted flap inset and microvascular anastomosis has recently shown promise. SummaryReconstruction and flap selection following TORS should be tailored to the patient and unique oropharyngeal defect. Functional outcomes are promising with low complication rates among these patients. Keywordsfree flap, locoregional flap, oropharyngeal reconstruction, transoral robotic surgery & ,5]. Importantly, TORS may obviate the need for open surgical approaches and adjuvant therapy, thereby reducing functional morbidity and toxicities [6,7 && ,8].Despite the advantages of robotic-assisted surgery, oropharyngeal resection with TORS may still result in sizeable defects which necessitate reconstruction. As indications for TORS expand to include larger and more complex resections, careful consideration is required to select the most appropriate

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Facial artery musculomucosal flaps in oropharyngeal reconstruction following salvage transoral robotic surgery: a review of outcomes

Cited by 9 publications

References 29 publications

Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

A Rare Presentation of Recalcitrant Oropharyngeal Stenosis in a 54-Year-Old Male Patient Following Transoral Robotic Surgery for Obstructive Sleep Apnea

Oropharyngeal reconstruction after transoral robotic surgery

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