Head and neck reconstruction can be complex due to its 3D conformation. The patient’s function and aesthetics can be compromised after the primary reconstruction, affecting quality of life. This is not only aggravated by a mutilating surgery but also worsened by postoperative radiotherapy. Therefore, secondary revisions must be available and offered to adequate candidates at an adequate timing in order to improve their post-treatment disease-free condition.
The areas that are specially affected by these deleterious sequelae are the oral cavity and perioral tissue. Common sequelae include drooling, trismus, oral incompetency and microstomia, which can cause difficulty in feeding and therefore encourage malnutrition. Deglutition and phonation alteration may appear after tongue, floor of the mouth and palate reconstruction. Because it involves the face, suboptimal reconstruction can have a significant psychological impact on the patient. Aesthetic deformity may be observed after tissue atrophy or scarring, giving a sunken appearance. The opposite may occur in bulky flaps, which intraorally can also affect deglutition and phonation. Flap skin colour mismatch can be visually uncomfortable for the patient. Secondary procedures such as flap debulking or augmentation, commissuroplasties, lip reposition, trismus release, contracture release or implants/prosthesis may be offered to improve the patient’s condition.
As each case is different, the necessities and indications should be assessed individually and cannot be generalized. It should be remembered that these are elective procedures and that the main goal is to improve quality of life, which is a subjective parameter. The gains and the side effects should be carefully discussed with the patient. The patient’s starting point, present condition and prognosis and individual needs should be addressed altogether in order to correctly indicate and successfully perform a secondary revision.
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