Cancer of the palate: Plastic repair versus prosthesis

Abstract

We have become increasingly convinced at Johns Hopkins Hospital that surgical repair of large palatal defects is warranted in the vast majority of instances. The impetus for repair has come to us from patients who have been unhappy with prostheses. The sophistication of general surgical and plastic training has produced an adequate number of surgeons now trained to perform not only extirpation but the equally important reconstruction of the resulting defects. Reconstruction should always be planned and often initiated at the time of original resection of palatal tumors. Of course, highly suspicious margins should not be hidden from view until they are shown to be tumor free clinically and on biopsy. Small palatal defects may close spontaneously. Moderately sized ones may require local oral tissue repair. With larger defects the cervical and forehead tissues are the prime donor sites for flap migration. They permit rapid transfer with minimal deformity, cost and inconvenience to the patient. We prefer not to pass such flaps through the mouth to reach the palate, but prefer access by means of an existing orbital or facial defect, or by incision through the floor of the mouth. Surgeons are urged to think more often of immediate split grafting of the nasal mucosa and the immediate use of pharyngeal flaps with removal of smaller tumors from the palate. Our experience with this group of patients has demonstrated that the use of autogenous living tissue for the repair of acquired defects of the palate offers many advantages that have long been recognized in the surgery of congenital clefts.