Reconstruction of TORS oropharyngectomy defects with the nasoseptal flap via transpalatal tunnel
- 1 Downloads
The nasoseptal flap (NSF) has been described as reconstructive option for soft palate defects following transoral robotic surgery (TORS). As described, this technique is does not provide adequate coverage of the lateral oropharyngeal wall, parapharyngeal space, exposed vessels, or exposed mandibular bone. The NSF for TORS reconstruction has been limited to soft palate reconstruction, given the limitations on length when passed via the nasopharynx. In this article, we describe (1) a novel technique for TORS reconstruction using direct transposition of the ipsilateral NSF into the oropharynx via a transpalatal tunnel at the hard–soft palate junction, and (2) its use in select patients.
KeywordsNasoseptal flap (NSF) Transoral robotic surgery (TORS) Robotic oropharyngectomy Robotic-assisted reconstruction Oropharyngeal reconstruction
The project was funded by SPORE Grant P50 CA097190 and T32 Grant CA060397, PI: Dr. Robert L. Ferris, MD, PhD, FACS. Statistical analysis was performed by Jad Ramadan, MS in the Department of Otolaryngology-Head and Neck Surgery West Virginia University.
Compliance with ethical standards
Conflict of interest
Robert L. Ferris, MD, PhD has the following disclosures: Amgen (Advisory Board); Astra-Zeneca/MedImmune (Advisory Board, Clinical trial, Research Funding); Bristol-Myers Squibb (Advisory board, Clinical trial, Research funding); EMD Serono (Advisory Board); Benetic (Advisory Board); Lilly (Advisory Board); Merck (Advisory Board, Clinical trial); Pfizer (Advisory Board); VentiRx Pharmaceuticals (Research funding). Meghan T. Turner, Mathew Geltzeiler, MD, W. Greer Albergotti, MD, Umamaheswar Duvvuri, MD, PhD, Seungwon Kim, MD, Eric W. Wang, MD, declare that they have no conflicts of interest. The NSF provides excellent local flap reconstruction for lateral oropharyngectomy defects following TORS. This is the first description of a laterally-based, pedicled NSF design utilization for ICA coverage during transoral surgery. This required minimal additional surgical time and was effective in preventing acute or delayed ICA bleeding. Additionally, it postoperative healing. Although reported here only during TORS oropharyngectomy, it is intuitive that this technique also applies to transoral laser microsurgery.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study per institutional protocols.
Supplementary material 1 (MP4 127971 kb)
- 1.Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116(10):1882–1886. https://doi.org/10.1097/01.mlg.0000234933.37779.e4 CrossRefGoogle Scholar
- 2.Peris-Celda M, Pinheiro-Neto CD, Funaki T, Fernandez-Miranda JC, Gardner P, Snyderman C, Rhoton AL (2013) The extended nasoseptal flap for skull base reconstruction of the clival region: an anatomical and radiological study. J Neurol Surg B Skull Base 74(6):369–385. https://doi.org/10.1055/s-0033-1347368 CrossRefGoogle Scholar
- 4.Zanation AM, Carrau RL, Snyderman CH, Germanwala AV, Gardner PA, Prevedello DM, Kassam AB (2009) Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy 23(5):518–521. https://doi.org/10.2500/ajra.2009.23.3378 CrossRefGoogle Scholar
- 5.Rivera-Serrano CM, Lentz AK, Pinheiro-Neto C, Snyderman CH (2013) Cadaveric study of the posterior pedicle nasoseptal flap: a novel flap for reconstruction of pharyngeal defects and velopharyngeal insufficiency. Plast Reconstr Surg 132(5):1269–1275. https://doi.org/10.1097/PRS.0b013e3182a4c37b CrossRefGoogle Scholar
- 12.Genden EM, Lee BB, Urken ML (2001) The palatal island flap for reconstruction of palatal and retromolar trigone defects revisited. Arch Otolaryngol Head Neck Surg 127(7):837–841Google Scholar
- 17.Holsinger FC, McWhorter AJ, Menard M, Garcia D, Laccourreye O (2005) Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: I. Technique, complications, and functional results. Arch Otolaryngol Head Neck Surg 131(7):583–591. https://doi.org/10.1001/archotol.131.7.583 CrossRefGoogle Scholar