Functional results after reconstruction of oral and oropharyngeal defects

The objective of this study was to investigate problems of reconstruction and postoperative function in treated patients with oral and oropharyngeal cancer. 1) Reconstruction of total or subtotal glossectomy. We compared the postoperative function between reconstruction with bulky flaps and that with nonbulky flaps. Most of the patients treated with bulky flaps had satisfactory swallowing and speech function outcomes. However, in patients treated with nonbulky flaps, severe postoperative function was more common. We suggest that wider and thicker flaps such as a rectus abdominis musculocutaneous flap be selected to reconstruct the bulky flap. Prevention of laryngeal prolapse by suspending the hyoid bone from the mandible with thick nylon is also useful to achieve satisfactory functional results 2) Reconstruction of lateral and superior oropharyngeal wall defects. Five operative procedures were performed: the patch, jump, denude, fold, and Gehanno procedures. Defects were classified into five types according to the extent of the defect (Ia, Ib, IIa IIb, and IIc). As for wound dehiscence, the Gehanno method is the most reliable and should be used. Most of the patients with type I, IIa, or IIb defects had satisfactory postoperative function. However, in patients with type IIc defects, severe velopharyngeal incompetence was more common. We suggest that patients in whom more than two-thirds of the anterior and posterior oropharyngeal walls have been resected are poor candidates for reconstruction with these static procedures.