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Douglas B. Chepeha, MD, MSPH; Assuntina G. Sacco, BS; Vanessa R. Erickson, MD; Teresa Lyden, MA, CCC-SLP; Marc Haxer, MA, CCC-SP; Jeffrey Moyer, MD; Theodoros N. Teknos, MD; Mark E. Prince, MD; Avraham Eisbruch, MD; Carol R. Bradford, MD; Gregory T. Wolf, MD

Arch Otolaryngol Head Neck Surg. 2009;135(9):887-894.

Objective  To determine if oropharyngoplasty using a Gehanno technique of superior constrictor velopharyngoplasty, base of tongue mounding, and primary hypopharyngeal closure in combination with template-based revascularized free tissue transfer is effective for reconstruction of the oropharyngeal defect.

Design  Prospective case series.

Setting  Tertiary care academic medical center.

Patients  The study population comprised 25 patients (21 men and 4 women; mean age, 55.3 years) presenting from January 1998 to January 2001 with oropharyngeal squamous cell carcinoma. A comparison was performed based on the percentage of resection of the soft palate (group 1, 50% palate; group 2, >50% palate).

Interventions  Of the 25 patients, 24 (96%) received radiotherapy. The donor sites were radial forearm for 23 of 25 patients (92%) and lateral arm for 2 of 25 patients (8%). The mean area was 92 cm² (range, 25-150 cm²), and the mean length of the velopharyngoplasty component of the oropharyngoplasty was 2.15 cm (range, 1-3 cm).

Main Outcome Measures  Gastrostomy tube dependence, major and minor complications, time to oral intake, speech and swallowing assessment, and quality-of-life assessment.

Results  Of the 25 patients, 2 (8%) remain gastrostomy dependent; 6 (24%) developed major complications; and 7 (28%) developed minor complications. Speech in both groups 1 and 2 was considered understandable most of the time, with occasional repetition. The group 1 patient with a median assessment score could eat a solid diet without restriction of place or person, whereas the group 2 patient with a median assessment score could eat a soft, moist diet with selected persons in selected places.

Conclusion  Integration of oropharyngoplasty with template-based revascularized free tissue transfer produced speech results that were independent of palate defect size, and swallow function test results were similar to other published reconstructive techniques.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor.

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