Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Basel, Switzerland
Tarek Ismail
Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Basel, Switzerland
Rik Osinga
Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Basel, Switzerland; Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, Switzerland; Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, UK; Praxis beim Merian Iselin, Thannerstrasse 80, Basel, Switzerland; REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
Maximilian Burger
Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Basel, Switzerland
Jens Jakscha
Department of Otolaryngology, Head and Neck Surgery, University Hospital Basel, Basel, Switzerland
Claude Fischer
HNO Zentrum Thun AG, Thun, Switzerland
Laurent Muller
Department of Otolaryngology, Head and Neck Surgery, University Hospital Basel, Basel, Switzerland
Carlo M. Oranges
Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva, Switzerland
Dirk J. Schaefer
Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Basel, Switzerland; Corresponding author. Dirk J. Schaefer, Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Spitalstrasse 21, CH-4031 Basel, Switzerland. Phone: 0041 61 265 73 49, Fax: 0041 61 265 73 01.
Summary: Background: The excision of oropharyngeal carcinoma of more than 50% of the soft palate followed by static reconstruction may result in functional deficits, including velopharyngeal insufficiency, swallowing, and speech difficulties. We describe a functional soft palate reconstruction technique aimed at restoring aeromechanical and acoustic functions, enabling swallowing without nasal regurgitation and speech with low nasalance. Material and Methods: We developed a new operative technique, using muscle transfer and a free flap to create a dynamic reconstruction. To prove the distinct nerve innervation of the two digastric bellies and the feasibility of the technique, we first performed an anatomical study, and then implemented the technique in our clinic. The surgical technique included transfer of the anterior and posterior bellies of the digastric muscle in association with a folded radial forearm free flap. A retrospective analysis of patients who underwent this soft palate functional reconstruction after cancer resection between 2007 and 2017 was performed, and a subjective analysis of nasalance and swallowing was done to evaluate the functional outcomes. Results: Eight patients (six males, two females) with a mean age of 56 years (range 43–69) who were affected by oropharynx carcinoma (stage T1-3) infiltrating the soft palate were included. Analysis of the reconstruction showed that seven of the eight patients had satisfactory swallowing function, and all patients were able to speak in an understandable manner with minimal nasalance. Conclusions: Our surgical approach provided a functional reconstruction with outcomes close to normality, making it a suitable technique for patients with large soft palate defects.
