Soft palate reconstruction after radionecrosis: Combined anterolateral thigh adipofascial and nasoseptal flaps |
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Authors: | Joseph Zenga Jeffrey D. Sharon Jennifer Gross Jay Gantz Patrik Pipkorn |
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Affiliation: | 1. Massachusetts Eye and Ear Infirmary, Harvard Medical School, Department of Otolaryngology-Head and Neck Surgery, Boston, MA, United States;2. University of California, San Francisco, Department of Otolaryngology-Head and Neck Surgery, San Francisco, CA, United States;3. Washington University, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, MO, United States |
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Abstract: | Although radiation-based treatment for nasopharyngeal cancer may achieve excellent long term oncologic results, late effects of therapy may lead to soft tissue radionecrosis and velopharyngeal insufficiency (VPI). Repair of these oro- and nasopharyngeal defects presents a complex reconstructive challenge. We present a case of a long-term survivor treated with chemoradiotherapy for nasopharyngeal cancer who developed progressive dysphagia, velopharyngeal insufficiency, and radionecrosis of the nasopharynx and soft palate, leading to tracheostomy and gastrostomy tube dependence. A staged reconstruction was performed, initially with a tubed nasoseptal flap for a creation of a mucosal-lined nasopharyngeal port. An adipofascial anterolateral thigh free flap was subsequently performed for soft palate reconstruction. Within 2 months, the oropharyngeal reconstruction had remucosalized and she was decannulated, taking an oral diet. Her speech was intelligible and she had good nasal breathing without symptoms of velopharyngeal insufficiency. |
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Keywords: | Radionecrosis Anterolateral thigh flap Nasoseptal flap Oropharyngeal reconstruction Nasopharyngeal cancer |
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