Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Soft palate cancer comprises around 15% of oropharyngeal cancers and may be treated with palatal ablation. Palatal reconstruction is complex and is associated with high rates of post-operative nasal regurgitation and hypernasal speech. Large tumor resection creates defects that necessitate free flap reconstruction to restore anatomical integrity and function. This study aims to evaluate the optimal type of free flap reconstruction of multicomponent soft palate defects to restore speech and swallowing function.
Methods: Retrospective chart review of patients who underwent soft palate reconstruction at Atrium Health Wake Forest Baptist between 2010 and 2020.
Results: Total patients: 26. Average age: 61.5 ± 11.4. Females 10/26 (38%) males 16/26 (62%). Reconstructive flap types: parascapula 8/26 (31%) and radial forearm 18/26 (69%). Squamous cell carcinoma was the most common indication for surgery: 22/26 (85%). Overall complication rate: 8/26 (31%). Most common complications: fistula 4/26 (15%) and wound dehiscence 2/26 (8%). All flaps survived and 3/26 (12%) required minor revision surgery. Long-term g-tube placement was noted in 9/26 (35%) patients for oropharyngeal dysphagia. Hypernasal speech developed in 2/26 (8%). There was no significant difference in complication rate between flap types. Prior radiation therapy was significantly associated with long-term g-tube placement (OR = 0.107, 95% CI: 0.015, 0.770, p=0.028).
Conclusions: Soft palate defects can be successfully repaired with multiple soft tissue free flaps. The high rate of permanent g-tube dependence highlights the morbidity of soft palate ablation and reconstruction. Prior radiation therapy may increase the risk of permanent g-tube placement.