Reconstruction of tissue defects after resection of tonsillar cancer by mandibular swing approach

Abstract

Objective:To explore the reconstruction methods of oropharyngeal defects after resection of tonsillar cancer by mandibular swing approach.Method:Twenty four cases of patients with tonsillar carcinoma hospitalized in our institution from January, 2010 to December, 2015 were analyzed. Based on the degree and extent of tissue defects, they were divided into three categories.①Small defects, including loss of tonsillar fossa and pharyngeal arches; ②Moderate defects, including small defects of soft palate or tongue root besides lateropharyngeal defects; ③Large defects, including large defects of soft palate and tongue root besides lateropharyngeal defects. The tissue defects of 8 patients belonged to small defects, of whom 4 cases were repaired with mid-thick skin and the others were restored by radial forearm flaps. There were 5 cases of patients with moderate oropharyngeal defects after surgery of tonsillar carcinoma. These defects were reconstructed by radial forearm flaps(2 cases) and anterolateral femoral skin flaps (3 cases) respectively, while the remaining large defects of 11 patients were renovated using pectoralis major myocutaneous flaps(9 cases) and anterolateral femoral skin flaps(2 cases). Result:All the patients healed by first intention after surgery.Four transplanted skin grafts on the regions of small defects survived completely.5 cases of radial forearm flaps and anterolateral femoral skin flaps also survived well, whereas only one radial forearm flap suffered from vascular crisis leading to failure at 5 days postoperatively. The necrotic flaps were then removed by submaxillary space and oral cavity and the wounds were self-healed. The tissue defects were successfully repaired by pectoralis major myocutaneous flaps. Although the surgical wounds swelled, they were obviously relieved half a year later. In the tonsillar cancer patients encroached on soft palates, one occurred nasopharyngeal reflux and 3 spoke vaguely but understandably. The other patients' function of chewing, deglutition, respiration and speech were restored well. Conclusion:Small defects after resection by mandibular swing approach could be repaired by mid-thick skin or radial forearm flaps. Moderate defects of T3 tonsillar cancer could be restored using radial forearm flaps or anterolateral femoral skin flaps, while anterolateral femoral skin flaps or pectoralis major myocutaneous flaps could reconstructed the large defects of T3 or T4 tonsillar cancer.