Reconstruction of Velopharyngeal Function after Resection of Lateral and Superior Oropharyngeal Cancer.

Lee, Hyoung Gyo; Tark, Min Soong; Kim, Cheol Hann; Shin, Ho Sung; Kang, Sang Gue; Lee, Young Man

Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2006;33(5):546-551.
Published online September 1, 2006.

Reconstruction of Velopharyngeal Function after Resection of Lateral and Superior Oropharyngeal Cancer.

Hyoung Gyo Lee, Min Soong Tark, Cheol Hann Kim, Ho Sung Shin, Sang Gue Kang, Young Man Lee

Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Seoul, Korea. tarkms@hosp.sch.ac.kr

Abstract

PURPOSE
The reconstruction of oropharyngeal defect after cancer surgery is very difficult because of their complicated structure and the functional importance to prevent velopharyngeal incompetence. In this article we investigated affecting factors of velopharyngeal function after reconstruction and a fundamental rule of reconstruction for saving their functions such as swallowing, speeching and breathing. METHODS: We classified 18 patients into three group under Kimata's grouping. Type I defect(6 patients) was healed by primary closure or secondary intention. In Type II or III defect, two operation methods were used - the folded flap(8 patients) and modified Gehanno method(4 patients), which include a lateral-posterior pharyngeal rotation-advancement flap. We evaluated wound dehiscence between the flap and the soft palate, speech intelligibility using Hirose's method, regurgitation during oral feeding, and hypernasality.
RESULTS
Most of type I or II defects patients recovered satisfactory velopharyngeal function. But, in patients with type III defects we found wound dehiscence, worse speech function, and common velopharyngeal incompetence.
CONCLUSION
The large defect size and presence of wound dehiscence are major factors of postoperative velopharyngeal function. We conclude that folded flap or modified Gehanno method is a good reconstructive operation method for broad contact between the flap and defect site, preventing wound problem.

Keywords: Velopharyngeal incompetence; Lateral and superior oropharyngeal defect