A variety of residual defects containing many sulci and fossae in the oropharyngeal cavity make it extremely difficult to achieve an adequate flap design as well as the functional reconstruction of the complex defects after ablation surgery for oropharyngeal tumors. This study attempted to standardize flap design for the different types of defects in order to produce a better functional reconstruction of intra-oral defects. The oropharyngeal defects were classified into 6 Zones. When the defect involves only the mouth floor, it was classified as Zone 1. A hemi tongue was classified as Zone 2. A defect involving the mouth floor and a part of the tongue was classified as Zone 3. A defect involving the mouth floor, a part of the tongue and the tonsil was classified as Zone 4. A defect involving the mouth floor, a part of the tongue, tonsil and soft palate was classified as Zone 5. A defect involving the pharyngeal wall was classified as Zone 6. The following four types of forearm free flap designs were applied to each defective Zone accordingly: Type I flap design - an unilobed design for reconstructing Zone 1, 2 and 6 defects, Type II design - bilobed design for reconstructing Zone 3 defects, Type III design - trilobed design for reconstructing Zone 4 defects and Type IV design for reconstructing Zone 5 defects. During 1999 to 2002, 91 patients with oropharyngeal defects underwent a reconstruction using these standardized forearm free flap designs. The Type I design was used in 41 cases, the Type II design in 18 cases, the Type III design in 10 cases and the Type IV design in 22 cases. In all patients, the decannulation was successful, and the swallowing and deglutination functions were within the normal parameters. There was less nasal escape of the voice and the regurgitation of food than that observed using the conventional flap design method. Effective and functional reconstructions with minimal morbidities are possible with the application of the standardized forearm free flap design in oropharyngeal defects.
Human ; Oropharyngeal Neoplasms/*surgery ; Oropharynx/*surgery ; *Reconstructive Surgical Procedures/methods ; *Surgical Flaps

Humans ; Lymph Nodes ; pathology ; surgery ; Neck Dissection ; methods ; Oropharyngeal Neoplasms ; pathology ; surgery

Hemorrhage ; Humans ; Natural Orifice Endoscopic Surgery ; Oropharyngeal Neoplasms/surgery* ; Robotic Surgical Procedures

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.
Carotid Arteries ; Free Tissue Flaps* ; Head and Neck Neoplasms ; Mouth ; Oropharyngeal Neoplasms ; Oropharynx ; Postoperative Complications ; Surgery, Plastic

Acellular Dermis ; Female ; Humans ; Male ; Oropharyngeal Neoplasms ; surgery ; Reconstructive Surgical Procedures ; Surgical Flaps ; Wound Healing

Objective: To compare the recovery and quality of life of patients with oral and oropharyngeal tumors treated with three kinds of free soft tissue flaps. Methods: The clinical data of 103 patients, including 66 males and 37 females, aged 26-74 years, who underwent primary repair of defects after resection of oral and oropharyngeal tumors in Sichuan Tumor Hospital from July 2014 to August 2020 were analyzed. Anterolateral thigh flap (ALTF) was used in 43 patients, radial forearm free flap (RFFF) in 45 patients, and lateral arm free flap (LAFF) in 15 patients. Postoperative qualities of life of patients were evaluated by the university of Washington quality of life questionnaire and oral health impact scale (HIP-14 Chinese edition). SPSS 23.0 software was used for statistical analysis. Results: The T staging of RFFF or LAFF group was significantly lower than that of ALTF group (P<0.05). There was no significant difference in mean flap areas between ALTF group ((55.87±27.38) cm²) and LAFF group ((49.93±19.44) cm²), while RFFF group had smaller mean flap area ((33.18±6.05) cm²) than ALTF group (t=5.311, P<0.001) and LAFF group (t=3.284, P=0.005). In terms of oral functions including swallowing, mastication, taste and spitmouth, there were no significant differences between LAFF group and RFFF group (P>0.05), but both groups had better oral functions than ALTF group (P<0.05). There was no significant difference in appearance scores between LAFF group (75(75, 75)) and ALTF group (75(75,75) vs.75(75,75),Z=-1.532, P=0.126), and both groups had higher scores than RFFF group (50(50, 75),Z values were -3.447 and -3.005 respectively, P<0.05). RFFF group had higher speech score (100(67, 100)) than LAFF group (67(50, 76),Z=-2.480, P<0.05) and ALTF group (67(33, 67),Z=-5.414, P<0.05). ALTF group had lower mean score of quality of life than RFFF group [72(56,77) vs.79(69, 89),Z=-3.070, P<0.05), but there was no statistical difference in the mean scores of qualities of life between ALTF group and LAFF group (Z=1.754, P=0.079). According to the evaluation of oral health impact scale (HIP-14 Chinese version) 1 year after surgery, individual item scores and the average score of all items in ALTF group were lower than those in RFFF and LAFF groups (P<0.05), with no significant difference between RFFF group and LAFF group (P>0.05). Conclusions: RFFF has unique advantages for small tissue defects, while ALTF is suitable for large tissue defects, such as buccal penetrating defect, whole tongue and near whole tongue defect, and LAFF is a compromise choice between ALTF and RFFF. ALTF is inferior to RFFF and LAFF in oral functional reconstruction, including swallowing, chewing, taste and spittle. ALTF and LAFF are superior to RFFF in postoperative appearance.
Female ; Forearm/surgery* ; Free Tissue Flaps ; Humans ; Male ; Oropharyngeal Neoplasms/surgery* ; Quality of Life ; Reconstructive Surgical Procedures ; Thigh/surgery*

OBJECTIVETo evaluate the clinical use of acellular dermal matrix (ADM) in the repair of pharynx.

METHODFrom June 2003 to December 2004, 18 cases of laryngopharyngeal carcinoma or oropharyngeal carcinoma accepted treatment of surgery. Four of them had the tumor in the place of posterior wall of laryngopharynx or oropharynx. In the operation, the tumor was resected and the function of larynx was reserved, reconstruction of the posterior wall of laryngopharynx or oropharynx was made with ADM. Three of them had normal function of vocal cords and the tumor was in the place of posterior wall of pharynx and lateral wall of piriform fossa. These patients accepted resection of the tumor and the larynx was reserved. ADM was sutured to the prevertebral fascia to repair the pharynx, reinforcement was made with sternocleidomastoid muscle then. The other 11 patients had the tumor in the pharynx and cervico-esophagus and the vocal cords were fixed. These cases accepted total resection of the larynx and laryngopharynx. ADM was sutured to the prevertebral fascia to repair the posterior wall of laryngopharynx, musculo-cutaneous flap of pectoralis major muscle was made to repair the anterior and lateral walls. All these 18 patients accepted radiotherapy after the operation, the dosage was 60-70 Gy.

RESULTSAmong all these 18 cases, no rejection of ADM or formation of pharynx fistula happened after the operation. The allograft became normal mucosa finally. Two patients had subcutaneous infection. After the treatment of dressing change and antibiotics, the wound healing was satisfying. All the 18 patients had resumption of oral diet finally but 3 of them had light mis-swallowing. Seven patients whose larynx were reserved had the trachea cannula pulled out The follow-up periods after the operation lasted 12 months to 30 months. The middle follow-up period was 19. 38 months. Neither rejection nor scar formation of the allograft happened. The follow-up of 11 patients lasted more than 18 months, 3 of them had relapse of tumor. After the second operation 1 patient was still alive and 2 patients died of distant metastasis.

CONCLUSIONADM can be easily obtained. Its histocompatibility were perfect The operative procedure were easy to perform. The complications of donor part can be totally avoided. The combined use of ADM and musculo-cutaneous flap of pectoralis major muscle or other neck tissue was safe and effective in the reconstruction of pharynx.

Aged ; Dermis ; transplantation ; Humans ; Male ; Middle Aged ; Oropharyngeal Neoplasms ; surgery ; Pharynx ; surgery ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps

OBJECTIVES: Occult cervical lymph node metastasis is the most important reason for recurrence of early-stage tongue cancer and oropharyngeal cancer. Cervical sentinel lymph node (SLN) biopsy may help to identify them. Pigment dyes and radionuclide were used to label SLN. Both of them had shortage. This study aims to investigate the application and clinical value of indocyanine green fluorescence imaging in cervical SLN biopsy for patients with early-stage tongue cancer and oropharyngeal cancer. METHODS: Retrospective analysis was conducted on 23 patients with early tongue cancer and oropharyngeal cancer, who received surgical treatment and used indocyanine green as a tracer to find SLN in Hunan Cancer Hospital from April to October 2021. The detection rate of SLN was calculated and the distribution of SLN in different regions of the neck was analyzed. RESULTS: SLN was successfully identified in 22 of 23 patients, with a detection rate of 95.65%. Among these 22 patients, 3 patients were found to have cancer metastasis, and the rate of occult lymph node metastasis was 13.63%. No pathologically positive lymph nodes were detected in SLN-negative patients, and thus the positive predictive rate was 100%. For patients with primary lesions located in the anterior 2/3 of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 15.15%, 71.72%, 13.13%, and 0, respectively. For patients with primary lesions located in base of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 0, 44.44%, 44.44%, and 11.12%, respectively. CONCLUSIONS Indocyanine green fluorescence imaging has a high detection rate with accurate positive prediction in the anterior cervical SLN biopsy in patients with early-stage tongue cancer and oropharyngeal cancer. Meanwhile, it can also reflect the lymphatic drainage of tumors located at different primary sites, which has high clinical value.
Humans ; Sentinel Lymph Node Biopsy/methods* ; Indocyanine Green ; Lymphatic Metastasis/pathology* ; Tongue Neoplasms/surgery* ; Retrospective Studies ; Lymph Nodes/pathology* ; Oropharyngeal Neoplasms/surgery* ; Tongue

Objective: To explore the therapeutic effects of transoral robotic surgery (TORS) and traditional surgical modes in oropharyngeal squamous cell carcinoma (OPSCC). Methods: The clinicopathological data of patients with oropharyngeal squamous cell carcinoma treated at Sun Yat-sen University Cancer Center from 2010 to 2018 were retrospectively analyzed. 135 cases were treated with traditional surgery (non-TORS group), while 52 cases were treated with TORS (TORS group). The prognosis of the two groups of patients were analyzed by Kaplan-Meier method and Log rank test, the influencing factors were analyzed by Cox regression model. Results: The 2-year overall survival (OS, 94.2%) and 2-year progression-free survival (PFS, 93.8%) of patients in the TORS group were better than those in the non-TORS group (71.4% and 71.4%, respectively, P<0.05). The 2-year OS (93.3%) and 2-year PFS (92.8%) of TORS group patients in T1-2 stage were better than those of non-TORS group (73.1% and 72.8%, respectively, P<0.05). The 2-year OS (95.8%) and 2-year PFS (95.2%) of patients with stage Ⅰ to Ⅱ in the TORS group were not significantly different from those in the non-TORS group (84.1% and 83.9%, respectively, P>0.05). The 2-year OS (92.9%) and 2-year PFS rate (92.7%) of patients with stage Ⅲ to Ⅳ in the TORS group were better than those in the non-TORS group (64.7% and 63.9%, respectively, P<0.05). The 2-year OS (94.4%) of HPV-positive patients in the TORS group was not significantly different from that in the non-TORS group (83.3%, P=0.222). The 2-year OS of HPV-negative patients in the TORS group (94.1%) was significantly different from that in the non-TORS group (43.7%, P<0.001). HPV status was an independent prognostic factor (P=0.008). Conclusions: TORS has a better prognosis in the treatment of oropharyngeal squamous cell carcinoma compared with the traditional treatment methods. The patients with T1-T2 can achieve better survival benefits after TORS treatment. The HPV-positive OPSCC patients has a better prognosis than that of HPV-negative OPSCC patients, and regardless of HPV status, OPSCC patients in the TORS group could obtain a better survival prognosis.
Head and Neck Neoplasms ; Humans ; Oropharyngeal Neoplasms/surgery* ; Papillomavirus Infections/complications* ; Retrospective Studies ; Robotic Surgical Procedures/methods* ; Squamous Cell Carcinoma of Head and Neck/surgery*

PURPOSE: To review the 5-year outcomes of our modified mandibulotomy technique. Retrospective review of a tertiary level oral cancer center. MATERIALS AND METHODS: During a 5-year period, 30 patients who had a uniform surgical technique consisting of a lower lip-splitting, modified stair-step osteotomy with thin saw blade and osteotome after plate-precontouring and combination fixation with monocortical osteosynthesis (miniplate) and bicortical osteosynthesis (maxiplate and bicortical screws), with at least 14 months postoperative follow-up, were selected and reviewed retrospectively. RESULTS: There were 8 women and 22 men with an average age of 56.5 years. All the patients involved malignancies were squamous cell carcinoma. The main primary sites of the those who underwent a mandibulotomy were the tonsil, the base of tongue, the oral tongue, the retromolar pad area, and others. Others included buccal cheek, floor of mouth, and soft palate. 23 patients received postoperative radiation therapy, and among whom 8 patients also received chemotherapy. Total four (13%) mandibulotomy-related complications occurred, only two (6.7%) requiring additional operation under general anesthesia. CONCLUSION: Our modified mandibulotomy meets the criteria for an ideal mandibulotomy technique relatively well because it requires no intermaxillary fixation, can precise preserve the occlusion in a precise way, allows early function, requires no secondary procedures, and has few complications.
Adult ; Aged ; Female ; Humans ; Male ; Mandible/*surgery ; Mandibular Osteotomy/adverse effects/*methods/standards ; Middle Aged ; Oropharyngeal Neoplasms/*surgery ; Postoperative Complications/*prevention & control ; Retrospective Studies