Meghan T Turner1, Mathew N Geltzeiler2, Jad Ramadan3, Jessica M Moskovitz4, Robert L Ferris5,6, Eric W Wang5, Seungwon Kim5. 1. Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia, U.S.A. 2. Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Oregon, Portland, U.S.A. 3. Blanchette Rockefeller Neurosciences Institute, West Virginia University Health Sciences Center, Morgantown, West Virginia, U.S.A. 4. Department of Otolaryngology-Head and Neck Surgery, Louisiana State University, Shreveport, Louisiana, U.S.A. 5. Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A. 6. Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS: To study use of the nasoseptal flap (NSF) to reconstruct lateral transoral robotic surgery (TORS) oropharyngectomy defects. STUDY DESIGN: Retrospective case series. METHODS: A clinical series of six patients undergoing NSF reconstruction of lateral TORS oropharyngectomy defects was retrospectively studied. All patients underwent TORS for the treatment of intermediate-risk human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma of the lateral pharyngeal wall between January and June 2017. All patients underwent NSF reconstruction of lateral TORS defects with retrospective analysis of outcomes and complications. RESULTS: Six patients underwent NSF reconstruction of lateral TORS defects. Operative times decreased from 180 minutes to 90 minutes over the study period. There were two cases of partial flap dehiscence and partial necrosis. There were no major donor site complications. All patients had temporary nasal obstruction and crusting. Two experienced temporary aural fullness. In all patients, the lateral wall was mucosalized in 1-3 weeks. Cephalometric analysis of preoperative imaging revealed that patients with high-arched palates (>3 cm) and defect lengths that are longer than NSF flap lengths are poor candidates for this technique. CONCLUSIONS: This NSF is a vascularized, locoregional rotational flap that can reconstruct lateral TORS defects in salvages cases or those where the parapharyngeal carotid or mandibular bone are exposed. Postoperative morbidity is limited to temporary nasal dyspnea, aural fullness, and crusting. Preoperative imaging can determine which patient will have successful defect coverage. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:53-60, 2022.
OBJECTIVES/HYPOTHESIS: To study use of the nasoseptal flap (NSF) to reconstruct lateral transoral robotic surgery (TORS) oropharyngectomy defects. STUDY DESIGN: Retrospective case series. METHODS: A clinical series of six patients undergoing NSF reconstruction of lateral TORS oropharyngectomy defects was retrospectively studied. All patients underwent TORS for the treatment of intermediate-risk human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma of the lateral pharyngeal wall between January and June 2017. All patients underwent NSF reconstruction of lateral TORS defects with retrospective analysis of outcomes and complications. RESULTS: Six patients underwent NSF reconstruction of lateral TORS defects. Operative times decreased from 180 minutes to 90 minutes over the study period. There were two cases of partial flap dehiscence and partial necrosis. There were no major donor site complications. All patients had temporary nasal obstruction and crusting. Two experienced temporary aural fullness. In all patients, the lateral wall was mucosalized in 1-3 weeks. Cephalometric analysis of preoperative imaging revealed that patients with high-arched palates (>3 cm) and defect lengths that are longer than NSF flap lengths are poor candidates for this technique. CONCLUSIONS: This NSF is a vascularized, locoregional rotational flap that can reconstruct lateral TORS defects in salvages cases or those where the parapharyngeal carotid or mandibular bone are exposed. Postoperative morbidity is limited to temporary nasal dyspnea, aural fullness, and crusting. Preoperative imaging can determine which patient will have successful defect coverage. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:53-60, 2022.
Authors: Maria Peris-Celda; Carlos Diogenes Pinheiro-Neto; Takeshi Funaki; Juan C Fernandez-Miranda; Paul Gardner; Carl Snyderman; Albert L Rhoton Journal: J Neurol Surg B Skull Base Date: 2013-06-17
Authors: John Gleysteen; Scott Troob; Tyler Light; Daniel Brickman; Daniel Clayburgh; Peter Andersen; Neil Gross Journal: Oral Oncol Date: 2017-05-09 Impact factor: 5.337
Authors: Gustavo Hadad; Luis Bassagasteguy; Ricardo L Carrau; Juan C Mataza; Amin Kassam; Carl H Snyderman; Arlan Mintz Journal: Laryngoscope Date: 2006-10 Impact factor: 3.325
Authors: Mark Kubik; Rajarsi Mandal; William Albergotti; Umamaheswar Duvvuri; Robert L Ferris; Seungwon Kim Journal: Head Neck Date: 2017-06-01 Impact factor: 3.147
Authors: Scott A Asher; Hilliary N White; Alexandra E Kejner; Eben L Rosenthal; William R Carroll; J Scott Magnuson Journal: Otolaryngol Head Neck Surg Date: 2013-04-12 Impact factor: 3.497