Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
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Oral and Oropharyngeal Reconstruction with a Free Flap

  • Jeong, Woo Shik (Department of Plastic and Reconstructive Surgery, Seoul Asan Medical Center, University of Ulsan College of Medicine) ;
  • Oh, Tae Suk (Department of Plastic and Reconstructive Surgery, Seoul Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2016.01.27
  • Accepted : 2016.02.11
  • Published : 2016.06.20
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Abstract

Extensive surgical resection of the aerodigestive track can result in a large and complex defect of the oropharynx, which represents a significant reconstructive challenge for the plastic surgery. Development of microsurgical techniques has allowed for free flap reconstruction of oropharyngeal defects, with superior outcomes as well as decreases in postoperative complications. The reconstructive goals for oral and oropharyngeal defects are to restore the anatomy, to maintain continuity of the intraoral surface and oropharynx, to protect vital structures such as carotid arteries, to cover exposed portions of internal organs in preparation for adjuvant radiation, and to preserve complex functions of the oral cavity and oropharynx. Oral and oropharyngeal cancers should be treated with consideration of functional recovery. Multidisciplinary treatment strategies are necessary for maximizing disease control and preserving the natural form and function of the oropharynx.

Keywords

References

  1. Korean Statistical Information Service. Cancer registration statics [Internet]. Daejeon: Statistics Korea; 2014 [cited 2016 Jun 4]. Available from: http://kosis.kr/eng/statisticsList/statisticsList_01List.jsp?vwcd=MT_ETITLE&parentId=D.
  2. Huber MA, Tantiwongkosi B. Oral and oropharyngeal cancer. Med Clin North Am 2014;98:1299-321. https://doi.org/10.1016/j.mcna.2014.08.005
  3. Marur S, Burtness B. Oropharyngeal squamous cell carcinoma treatment: current standards and future directions. Curr Opin Oncol 2014;26:252-8. https://doi.org/10.1097/CCO.0000000000000072
  4. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61:69-90. https://doi.org/10.3322/caac.20107
  5. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin 2013;63:11-30. https://doi.org/10.3322/caac.21166
  6. Blot WJ, McLaughlin JK, Winn DM, Austin DF, Greenberg RS, Preston-Martin S, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988;48:3282-7.
  7. Pulte D, Brenner H. Changes in survival in head and neck cancers in the late 20th and early 21st century: a period analysis. Oncologist 2010;15:994-1001. https://doi.org/10.1634/theoncologist.2009-0289
  8. Pignon JP, le Maitre A, Maillard E, Bourhis J. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009;92:4-14. https://doi.org/10.1016/j.radonc.2009.04.014
  9. Takes RP, Rinaldo A, Silver CE, Piccirillo JF, Haigentz M Jr, Suarez C, et al. Future of the TNM classication and staging system in head and neck cancer. Head Neck 2010;32:1693-711. https://doi.org/10.1002/hed.21361
  10. Disa JJ, Pusic AL, Hidalgo DA, Cordeiro PG. Microvascular reconstruction of the hypopharynx: defect classification, treatment algorithm, and functional outcome based on 165 consecutive cases. Plast Reconstr Surg 2003;111:652-60. https://doi.org/10.1097/01.PRS.0000041987.53831.23
  11. Disa JJ, Pusic AL, Mehrara BJ. Reconstruction of the hypopharynx with the free jejunum transfer. J Surg Oncol 2006;94:466-70. https://doi.org/10.1002/jso.20483
  12. Nuara MJ, Sauder CL, Alam DS. Prospective analysis of outcomes and complications of 300 consecutive microvascular reconstructions. Arch Facial Plast Surg 2009;11:235-9.
  13. Wong CH, Wei FC. Microsurgical free flap in head and neck reconstruction. Head Neck 2010;32:1236-45. https://doi.org/10.1002/hed.21284
  14. Choi JW, Lee MY, Oh TS. The application of multilobed flap designs for anatomic and functional oropharyngeal reconstructions. J Craniofac Surg 2013;24:2091-7. https://doi.org/10.1097/SCS.0b013e3182a2442c
  15. David S, Dassonville O, Poissonnet G, Chamorey E, Vallicioni J, Demard F, et al. Free-flap head and neck reconstruction failures: predictive factors and management. Ann Chir Plast Esthet 2011;56:308-14. https://doi.org/10.1016/j.anplas.2010.07.004
  16. Joo YH, Sun DI, Park JO, Cho KJ, Kim MS. Risk factors of free flap compromise in 247 cases of microvascular head and neck reconstruction: a single surgeon's experience. Eur Arch Otorhinolaryngol 2010;267:1629-33. https://doi.org/10.1007/s00405-010-1268-1
  17. Kruse AL, Luebbers HT, Gratz KW, Obwegeser JA. Factors influencing survival of free-flap in reconstruction for cancer of the head and neck: a literature review. Microsurgery 2010;30:242-8.
  18. Yanai C, Kikutani T, Adachi M, Thoren H, Suzuki M, Iizuka T. Functional outcome after total and subtotal glossectomy with free flap reconstruction. Head Neck 2008;30:909-18. https://doi.org/10.1002/hed.20804
  19. Airoldi M, Garzaro M, Raimondo L, Pecorari G, Giordano C, Varetto A, et al. Functional and psychological evaluation after flap reconstruction plus radiotherapy in oral cancer. Head Neck 2011;33:458-68. https://doi.org/10.1002/hed.21471
  20. Joo YH, Hwang SH, Park JO, Cho KJ, Kim MS. Functional outcome after partial glossectomy with reconstruction using radial forearm free flap. Auris Nasus Larynx 2013;40:303-7. https://doi.org/10.1016/j.anl.2012.07.012
  21. Kekatpure VD, Manjula BV, Mathias S, Trivedi NP, Selvam S, Kuriakose MA. Reconstruction of large composite buccal defects using single soft tissue flap: analysis of functional outcome. Microsurgery 2013;33:184-90. https://doi.org/10.1002/micr.22063
  22. Denewer AD, Setit AE, Hussein OA, Aly OF. Functinal and aesthetic outcome of reconstruction of large oro-facial defects involving the lip after tumor resection. J Egypt Natl Canc Inst 2006;18:61-6.
  23. Seikaly H, Rieger J, Zalmanowitz J, Tang JL, Alkahtani K, Ansari K, et al. Functional soft palate reconstruction: a comprehensive surgical approach. Head Neck 2008;30:1615-23. https://doi.org/10.1002/hed.20919
  24. Iseli TA, Yelverton JC, Iseli CE, Carroll WR, Magnuson JS, Rosenthal EL. Functional outcomes following secondary free flap reconstruction of the head and neck. Laryngoscope 2009;119:856-60. https://doi.org/10.1002/lary.20200
  25. Archontaki M, Athanasiou A, Stavrianos SD, Korkolis DP, Faratzis G, Papadopoulou F, et al. Functional results of speech and swallowing after oral microvascular free flap reconstruction. Eur Arch Otorhinolaryngol 2010;267:1771-7. https://doi.org/10.1007/s00405-010-1275-2
  26. Andrades P, Pehler SF, Baranano CF, Magnuson JS, Carroll WR, Rosenthal EL. Fistula analysis after radial forearm free flap reconstruction of hypopharyngeal defects. Laryngoscope 2008;118:1157-63. https://doi.org/10.1097/MLG.0b013e31816f695a
  27. Lin YS, Wang CT, Chen YT, Chen KT. Carotid blowout syndrome. Ulus Travma Acil Cerrahi Derg 2015;21:68-70. https://doi.org/10.5505/tjtes.2015.76992
  28. Davis WJ, 3rd, Wu C, Sieber D, Vandevender DK. A comparison of full and split thickness skin grafts in radial forearm donor sites. J Hand Microsurg 2011;3:18-24.
  29. Wirthmann A, Finke JC, Giovanoli P, Lindenblatt N. Long-term follow-up of donor site morbidity after defect coverage with Integra following radial forearm flap elevation. Eur J Plast Surg 2014;37:159-66. https://doi.org/10.1007/s00238-013-0918-0
  30. Wester JL, Pittman AL, Lindau RH, Wax MK. AlloDerm with splitthickness skin graft for coverage of the forearm free flap donor site. Otolaryngol Head Neck Surg 2014;150:47-52. https://doi.org/10.1177/0194599813513713
  31. Toschka H, Feifel H, Erli HJ, Minkenberg R, Paar O, Riediger D. Aesthetic and functional results of harvesting radial forearm flap, especially with regard to hand function. Int J Oral Maxillofac Surg 2001;30:42-8. https://doi.org/10.1054/ijom.2000.0005
  32. Riecke B, Assaf AT, Heiland M, Al-Dam A, Grobe A, Blessmann M, et al. Local full-thickness skin graft of the donor arm: a novel technique for the reduction of donor site morbidity in radial forearm free flap. Int J Oral Maxillofac Surg 2015;44:937-41. https://doi.org/10.1016/j.ijom.2015.02.021
  33. Hanna TC, McKenzie WS, Holmes JD. Full-thickness skin graft from the neck for coverage of the radial forearm free flap donor site. J Oral Maxillofac Surg 2014;72:2054-9. https://doi.org/10.1016/j.joms.2014.05.015
  34. Jeong WS, Choi JW, Oh TS. Comparison study between coverage choices for radial forearm free flap donor site. Korean J Heak Neck Oncol 2015;31:5-8.

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