The folded radial forearm flap in soft-palate and tonsillary fossa reconstruction: technical note

Biglioli, Federico; Brusati, Roberto

doi:10.1016/j.ijom.2007.07.023

Cited by 17 publications

(13 citation statements)

References 15 publications

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“…However, suboptimal results have included perceptible nasal air leakage during speech in 1 patient 17 and a subjective semi-solid feeding in 2 patients. 17 We believe that the discomforts resulted from the large volume of the flap, which blocked the oronasal passage. In our study, we designed the flap as a 20% enlarged size to account for shrinkage after reconstruction and to reduce the soft tissue volume around the airway by making round angle of the oral and nasal plane by cutting the edge of the square plane of the flap to a round shape.…”

Section: Discussionmentioning

confidence: 98%

“…There are 2 goals of reconstruction: to restore continuity to the nasopharyngeal structure, which is interrupted by the dissection, enabling the residual muscles to provide velopharyngeal function; and to line the dissected surfaces so as to avoid extensive cicatricial retraction that would hinder the action of these muscles. 17 By considering the 3-dimensional plane, velopharyngeal function has been improved. However, suboptimal results have included perceptible nasal air leakage during speech in 1 patient 17 and a subjective semi-solid feeding in 2 patients.…”

Section: Discussionmentioning

confidence: 99%

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Modified Folding Radial Forearm Flap in Soft Palate and Tonsillar Fossa Reconstruction

Kang

Park

Lim

et al. 2013

Journal of Craniofacial Surgery

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Wide excision of cancer arising from the tonsillar fossa and soft palate has several functional sequelae (e.g., speech, swallowing, chewing, and breathing) that require surgical restoration of the pharyngeo-palatal structure and optimal velopharyngeal function. For this purpose, several kinds of surgical procedures have been introduced. Our method to reconstruct the tonsillar fossa and soft palate entails folding the flaps and reconstructions at the same time as the oral and nasal planes, with some modifications.Patient 1 was a 64-year-old man with left soft palate cancer. After wide excision of the tumor, the defect size of the nasal floor was 3 × 3 cm, and that of soft palate and tonsillar fossa was 8 × 5 cm. Patient 2 was a 49-year-old man with left tonsil cancer. The defect size of the nasal floor was 3 × 3 cm, and that of left lateral wall of the tonsillar fossa was 8 × 3 cm. For reconstruction of oral, nasal, and tonsillar plane, we designed the flap fit to the defect site, especially cutting of the edge of the square plane of the flap to a round shape.Both patients achieved good functional recovery without surgical complications. The average speech intelligibility score in the 2 patients was 10. Swallowing functional score was 4 in both patients. Creative reconstruction with modified radial forearm free flap for tonsillar and soft palate area makes it possible to restore velopharyngeal function to levels close to the preoperative condition.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Modified Folding Radial Forearm Flap in Soft Palate and Tonsillar Fossa Reconstruction

Kang

Park

Lim

et al. 2013

Journal of Craniofacial Surgery

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“…Soft‐palate reconstruction with local mucosal flaps, such as the buccinator myomucosal flap, has previously been reported; however, because the soft‐plate defects in the present cases were too extensive to be repaired with local mucosal flaps, free‐flap transfer became the first choice. Although the ALT flap has emerged as a versatile option for head and neck reconstruction, the RF flap remains the flap of choice for soft‐palate reconstruction because it is thin and pliable . In most reports, the RF flap is folded to reconstruct both the nasal and oral surfaces of the soft palate with the aim of restoring normal palatal anatomy .…”

Section: Discussionmentioning

confidence: 99%

“…Although the ALT flap has emerged as a versatile option for head and neck reconstruction, the RF flap remains the flap of choice for soft‐palate reconstruction because it is thin and pliable . In most reports, the RF flap is folded to reconstruct both the nasal and oral surfaces of the soft palate with the aim of restoring normal palatal anatomy . McCombe et al have used this method to reconstruct defects due to total or subtotal palatectomy; however, reported speech and swallowing functions were unsatisfactory .…”

Section: Discussionmentioning

confidence: 99%

“…To reconstruct defects larger than half of the soft palate, several surgical techniques have been used; the technique of first choice has been the use of microvascular free flaps. The flap of choice for the soft palate has been the radial forearm (RF) flap, which is thin and pliable; however, the RF flap requires an extremely complex folding procedure, and dehiscence of the palatal edge often occurs . Therefore, to reconstruct extensive defects of the soft palate we have used the combination of an anterolateral thigh (ALT) flap and a superiorly based pharyngeal flap.…”

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confidence: 99%

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Combined use of anterolateral thigh flap and pharyngeal flap for reconstruction of extensive soft‐palate defects

et al. 2015

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A Review of and Algorithmic Approach to Soft Palate Reconstruction

Britt

Hwang

Day

et al. 2019

JAMA Facial Plast Surg

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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.

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The folded radial forearm flap in soft-palate and tonsillary fossa reconstruction: technical note

Cited by 17 publications

References 15 publications

Modified Folding Radial Forearm Flap in Soft Palate and Tonsillar Fossa Reconstruction

Modified Folding Radial Forearm Flap in Soft Palate and Tonsillar Fossa Reconstruction

Combined use of anterolateral thigh flap and pharyngeal flap for reconstruction of extensive soft‐palate defects

A Review of and Algorithmic Approach to Soft Palate Reconstruction

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