The island cheek flap: repair of cervical esophageal stricture and new extended indications.

Seven patients had reconstruction with an island cheek flap based on the facial vein and artery. The flap carries a swatch of buccal mucosa that can be rotated inferiorly as far as the superior mediastinum and superiorly to the oral cavity. Five patients had repair of cervical esophageal strictures and fistulas. In four, results were very successful. One patient had diminished but persistent dysphagia which was shown to be secondary to a carcinomatous polyneuropathy; however, he had complete resolution of aspiration after correction of his mechanical obstruction and tracheoesophageal fistula. Morbidity was minimal. Parotiditis developed in one patient who had Stensen's duct ligated. Minor numbness of the lip and a single case of Frey's syndrome were also observed. In another patient, reconstruction of the floor of the mouth preserved normal speech and swallowing. Finally, a permanent speech fistula was also created but was substantially taken down because of functional dissatisfaction. Other potential applications need to be explored.