Reconstruction of the Dynamic Velopharyngeal Function by Combined Radial Forearm-Palmaris Longus Tenocutaneous Free Flap, and Superiorly Based Pharyngeal Flap in Postoncologic Total Palatal Defect

Takashi Nuri*, Koichi Ueda, Akira Yamada, Masashi Okada, Mai Hara

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

We attempted to reconstruct dynamic palatal function using a radial forearm-palmaris longus tenocutaneous free flap in conjunction with a pharyngeal flap for a postoncologic total-palate defect in a 67-year-old male patient. This reconstruction involved 3 important tasks, namely, separating the oral and nasal cavities, preserving the velopharyngeal space to avoid sleep apnea, and maintaining velopharyngeal closure to avoid nasal regurgitation during swallowing. In our technique, the radial forearm flap separates the oral and nasal cavities with an open rhinopharyngeal space, and a superiorly based pharyngeal flap, which is sutured to the posterior end of the forearm flap, limits the rhinopharyngeal space, and forms the bilateral velopharyngeal port. Furthermore, the palmaris longus tendon, which is attached to the forearm flap, is secured to the superior constrictor muscle to create a horizontal muscle sling. Contraction of the superior constrictor muscle leads to shrinkage of the sling, resulting in velopharyngeal closure. Swallowing therapy was started 4 weeks after the surgery. The patient could resume oral intake without any difficulties 6 months after the surgery. Speech intelligibility changed from severe to minimal hypernasality.

Original languageEnglish (US)
Pages (from-to)437-441
Number of pages5
JournalAnnals of plastic surgery
Volume74
Issue number4
DOIs
StatePublished - Apr 4 2015

Keywords

  • head and neck reconstruction
  • palatal defect
  • palmaris longus tendon
  • pharyngeal flap
  • radial forearm free flap
  • reconstruct the function
  • velopharyngeal incompetence

ASJC Scopus subject areas

  • Surgery

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