REPAIR AND FUNCTIONAL RECONSTRUCTION OF OROPHARYNGEAL DEFECTS AFTER RESECTION OF ADVANCED-STAGE TONSILLAR CANCER_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LUO Xianyang , ZHAO Dean , GUAN Limei , ZHOU Yi , SHANGGUAN Hanjing.

Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Xiamen University, Xiamen Fujian, 361003, P.R.China.;

Corresponding author：

Keywords：

Tonsillar neoplasm ，Surgical flap ，Tissue defect ，Repair and reconstruction

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【Abstract】 Objective To study the repair and functional reconstruction of oropharyngeal defects after resection of advanced-stage tonsillar cancer, and to select the donor site of appropriate flap. Methods Between October 2000 and February 2010, 13 patients with advanced-stage tonsillar cancer were treated, including 5 cases of high differentiation squamous cell carcinomas and 8 cases of medium differentiation squamous cell carcinomas. There were 11 males and 2 females, with an average age of 53.6 years (range, 39-67 years). According to Union for International Cancer Control (UICC) 1997 standards of oropharyngeal cancer, 1 case was classified as T1N1M0, 2 as T2N1M0, 2 as T2N2M0, 3 as T3N1M0, 2 as T3N2M0, 2 as T4N1M0, and 1 as T4N2M0. The disease duration was 1-8 months with an average of 4.3 months. The tumor invaded lateral wall of nasopharyngeal in 1 case, lateral wall of hypopharynx in 3 cases, epiglottis in 1 case, soft palate in 4 cases, and tongue root in 3 cases. The tumor infiltrating range was from 2 cm × 2 cm to 12 cm × 6 cm. All the 13 cases underwent integrated methods of surgery and postoperative radiotherapy. After resection of tumor by combined neck-mandible-oral cavity approach, pectoralis major myocutaneous flaps were transplanted in 5 cases, forearm free skin flaps in 5 cases, and anterolateral thigh free skin flaps in 3 cases. Results The postoperative pathological results showed 10 cases of cervical lymph node metastasis; 2 cases had local recurrence and 3 cases had cervical lymph node metastasis after postoperative radiotherapy. Neck infection occurred at 5 days after operation in 1 case undergoing transplantation of pectoralis major myocutaneous flap, and vascular crisis occurred at 12 hours after operation in 1 case undergoing transplantation of forearm free skin flap, which were cured after correspondent treatments. The other flaps survived with incision healing by first intention. Second suture was carried out in 1 case undergoing anterolateral thigh free skin flap transplantation because of wound disruption at the donor site. All the patients were followed up 1 to 6 years, with an average of 3.6 years. In 5 cases undergoing pectoralis major myocutaneous flap transplantation, swallowing obstruction and stomatolalia occurred. In 8 cases undergoing free skin flaps transplantation, the appearances of the flaps and the functions of swallowing or speaking were satisfactory, with no dysfunction at the donor site. All the patients returned to normal occlusion, facial appearance and function were normal. According to the direct calculation method, the three-year survival rate was 60.0% (6/10), and five-year survival rate was 37.5% (3/8). Conclusion For the patients with advanced-stage tonsillar cancer, forearm free skin flaps, or anterolateral thigh free skin flaps is the first choice for repairing defect. However, it is better to choose pectoralis major myocutaneous flaps in patients who need large flap and fail to radiotherapy.

Citation： LUO Xianyang,ZHAO Dean,GUAN Limei,ZHOU Yi,SHANGGUAN Hanjing.. REPAIR AND FUNCTIONAL RECONSTRUCTION OF OROPHARYNGEAL DEFECTS AFTER RESECTION OF ADVANCED-STAGE TONSILLAR CANCER. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(1): 50-54. doi: Copy

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2.	吴昊, 栾信庸, 卢军, 等. 扁桃体癌手术及修复方法的选择. 中国耳鼻咽喉头颈外科, 2007, 14(4): 179-181.
3.	唐平章, 张宗敏, 祁永发, 等. 303例下咽癌的外科治疗及组织移植修复重建术的临床分析. 中华耳鼻咽喉科杂志, 2004, 39(3): 166-170.
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11.	毛驰, 俞光岩, 彭歆, 等. 192例头颈部游离组织瓣移植的临床分析. 中华整形外科杂志, 2002, 18(2): 104-106.
12.	刘巍巍, 刘学奎, 郭朱明, 等. 应用游离股前外侧皮瓣修复头颈部软组织缺损. 癌症, 2009, 28(10): 1088-1092.
13.	张涤生. 整复外科学. 北京: 人民卫生出版社, 2002: 137-138.
14.	Disa JJ, Pusic AL, Hidalgo DH, et al. Simplifying microvascular head and neck reconstruction: a rational approach to donor site selection. Ann Plastic Surg, 2001, 47(4): 385-389.
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16.	Jeng SF, Kuo YR, Wei FC, et al. Total lower lip reconstruction with a composite radial forearm-palmaris longus tendon flap: a clinical series. Plast Reconstr Surg, 2004, 113(1): 19-23.
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20.	, 33(4): 378-380.

1. 张立强, 解光, 潘新良, 等. 扁桃体癌的手术治疗. 中华肿瘤杂志, 2003, 25(6): 596-598.
2. 吴昊, 栾信庸, 卢军, 等. 扁桃体癌手术及修复方法的选择. 中国耳鼻咽喉头颈外科, 2007, 14(4): 179-181.
3. 唐平章, 张宗敏, 祁永发, 等. 303例下咽癌的外科治疗及组织移植修复重建术的临床分析. 中华耳鼻咽喉科杂志, 2004, 39(3): 166-170.
4. UICC. TNM classification of malignant tumors. 5th ed. New York: Wiley-Liss, 1997.
5. 布洁, 高黎明, 徐国镇. 扁桃体癌的放射治疗. 国外医学: 肿瘤学分册, 2000, 27(6): 335-338.
6. 罗京伟, 徐国镇, 屠规益. 放疗在头颈部癌临床治疗中的作用. 中华耳鼻咽喉头颈外科杂志, 2005, 40(11): 877-880.
7. Sesterhenn AM, Zimmermann AP, Wagner U, et al. Improved technique of harvesting the pectoralis major myocutaneous flap for reconstruction in female head ＆ neck cancer patients. Clin Otolaryngol,.
8. 陈延武, 李劲松, 林钊宇, 等. 带蒂胸大肌皮瓣转移修复口咽癌根治术后大型组织缺损. 实用医学杂志, 2009, 25(15): 2492-2493.
9. 宋明, 陈文宽, 郭朱明, 等. 胸大肌肌皮瓣在晚期头颈肿瘤术后组织缺损重建中的应用. 癌症, 2008, 27(1): 58-61.
10. 张森林, 孟昭业, 董震, 等. 胸大肌肌皮瓣与钛板联合修复口腔癌根治术后的下颌骨缺损. 中国修复重建外科杂志, 2005, 19(10): 793-795.
11. 毛驰, 俞光岩, 彭歆, 等. 192例头颈部游离组织瓣移植的临床分析. 中华整形外科杂志, 2002, 18(2): 104-106.
12. 刘巍巍, 刘学奎, 郭朱明, 等. 应用游离股前外侧皮瓣修复头颈部软组织缺损. 癌症, 2009, 28(10): 1088-1092.
13. 张涤生. 整复外科学. 北京: 人民卫生出版社, 2002: 137-138.
14. Disa JJ, Pusic AL, Hidalgo DH, et al. Simplifying microvascular head and neck reconstruction: a rational approach to donor site selection. Ann Plastic Surg, 2001, 47(4): 385-389.
15. 许光普, 刘均墀, 曾宗渊, 等. 吻合血管的股前外侧皮瓣修复头颈肿瘤术后复杂缺损. 中华显微外科杂志, 2002, 25(3): 177-179.
16. Jeng SF, Kuo YR, Wei FC, et al. Total lower lip reconstruction with a composite radial forearm-palmaris longus tendon flap: a clinical series. Plast Reconstr Surg, 2004, 113(1): 19-23.
17. Wei FC, Jain V, Celik N, et al. Have we found an ideal softtissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg, 2002, 109(7): 2219-2230.
18. Ozkan O, Mardini S, Chen SC, et al. Repair of buccal defects with anterolateral thigh flaps. Microsurgery, 2006, 26(3): 182-189.
19. Amin A, Refaat M, Civantos F, et al. Free anterolateral thigh flap for reconstruction of major craniofacial defects. J Reconstr Microsurg, 2006, 22(2): 97-104.
20. , 33(4): 378-380.

Chinese Journal of Reparative and Reconstructive Surgery

REPAIR AND FUNCTIONAL RECONSTRUCTION OF OROPHARYNGEAL DEFECTS AFTER RESECTION OF ADVANCED-STAGE TONSILLAR CANCER

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