Reconstructive Surgery after Tumor Resection in the Oral Cavity and Oropharynx

Abstract

Background: Surgery is the most effective therapy of squamous-cell carcinoma of most sides of the head and neck. Tumor resection in the oral cavity and oropharynx often leaves large defects, requiring reconstructive procedures to avoid major functional impairment. Patients and Methods: We report about 150 patients in whom we performed a reconstruction of the oral cavity and oropharynx with a radial forearm-flap after resection of squamous-cell carcinoma. The forearm-flap was harvested from the distal volar aspect of the forearm based on the radial artery and comitant veins. Results: 49 patients (32.7%) had carcinomas of the oral cavity, 101 patients (67.3%) had carcinomas of the oropharynx. 132 patients (88%) showed an uneventful postoperative course. In 18 patients we found a flap necrosis due to thrombosis of the reanastomosed vessels. These patients had to undergo further reconstructive procedures, either with another microvascular free flap or a pedicled flap. Functional impairment was found especially in tumors of the base of tongue and other sites of the oropharynx. This includes, besides swallowing problems, also disturbances of speech and, in a few cases, of respiration. 3 patients could not be decannulated. The 50% survival rate over all stages (Kaplan-Meier) is 44 months. Conclusions: Despite wide tumor resection margins during surgery, enabled by the possibility of reconstructive procedures, the survival time did not improve, compared to a large group of patients reported in the literature who did not undergo reconstructive procedures. However, this time-consuming operative technique is justified by the improved functional result.

Swallowing outcomes following primary surgical resection and primary free flap reconstruction for oral and oropharyngeal squamous cell carcinomas: A systematic review

“…Three of the included studies utilized subjective methods to assess swallowing outcomes . Twelve studies used objective methods of assessment . Subjective evaluation included the self‐administered MDADI and UW‐QOL .…”

“…Subjective evaluation included the self‐administered MDADI and UW‐QOL . Six studies utilized gastrostomy dependency, and seven studies utilized tracheostomy dependency as a measure of swallowing assessment . Five studies employed bolus transit time measured with VFSS in the assessment of swallowing .…”

“…Five studies employed bolus transit time measured with VFSS in the assessment of swallowing . Nine studies reviewed the presence of aspiration via VFSS or FEES in the evaluation of swallowing . The results of the swallowing outcomes are presented below, with a summary of included studies in Table .…”

“…Due to the small numbers present in included studies with no randomization present, the confounding biases could not be controlled. Two studies included patients with varying tumor (T) stages with swallowing outcome results combined together . This commonly occurs in surgical studies due to the small population numbers present.…”

“…This commonly occurs in surgical studies due to the small population numbers present. The two publications had sound methodology and were included in the systematic review . However, this added confounding bias to the studies.…”