Modified Folding Radial Forearm Flap in Soft Palate and Tonsillar Fossa Reconstruction

Abstract

Wide excision of cancer arising from the tonsillar fossa and soft palate has several functional sequelae (e.g., speech, swallowing, chewing, and breathing) that require surgical restoration of the pharyngeo-palatal structure and optimal velopharyngeal function. For this purpose, several kinds of surgical procedures have been introduced. Our method to reconstruct the tonsillar fossa and soft palate entails folding the flaps and reconstructions at the same time as the oral and nasal planes, with some modifications.Patient 1 was a 64-year-old man with left soft palate cancer. After wide excision of the tumor, the defect size of the nasal floor was 3 × 3 cm, and that of soft palate and tonsillar fossa was 8 × 5 cm. Patient 2 was a 49-year-old man with left tonsil cancer. The defect size of the nasal floor was 3 × 3 cm, and that of left lateral wall of the tonsillar fossa was 8 × 3 cm. For reconstruction of oral, nasal, and tonsillar plane, we designed the flap fit to the defect site, especially cutting of the edge of the square plane of the flap to a round shape.Both patients achieved good functional recovery without surgical complications. The average speech intelligibility score in the 2 patients was 10. Swallowing functional score was 4 in both patients. Creative reconstruction with modified radial forearm free flap for tonsillar and soft palate area makes it possible to restore velopharyngeal function to levels close to the preoperative condition.

The “Kite-t-FAMMIF”: A Novel Technique for Reconstruction of Extensive Soft Palate Resection

“…Several modifications on the flap design, such as the folded RFFF, have been proposed to overcome these problems. 5 , 6 Nevertheless, RFFF requires microanastomoses, long operating time, carries a high risk of donor site morbidity, and does not adhere to the principle of “replacing like with like.”…”

“…They allow for the replacing of the soft palate with similar featured tissues (thin, mobile, well-vascularized, and sensitive tissue with a secretory glandular function), do not require two surgical teams, may be quickly harvested with low donor-site morbidity, are hairless, and more pliable than a skin flap with no shrinking observed during healing or radiotherapy. [1][2][3][4][5][6][7][8] Furthermore, good functional outcomes and a high degree of sensorial recovery have been previously demonstrated with these flaps. 9 In 2013, Massarelli et al 10 believed that they offered the best functional results and described the double-layer reconstruction of a total soft-palate defect using a single "folded" t-FAM-MIF because at that time, surgical soft-palate reconstruction techniques were focused on the morphological restoration of two layers (oral and nasal).…”

The Neutrophil-to-Lymphocyte ratio as a marker of recovery status in patients with severe dental infection

“…There is a high risk for lethal complications due to the anatomical connectivity of potential spaces in infections. The main reasons for hospitalization are pain, fever, and dysphagia ( 12 - 14 ). Early surgical drainage, hospitalization and antimicrobial treatment may be required.…”

Patient with Psychosis Undergoing Cheek Reconstruction

“…The radial forearm flap has been found to be a suitable and useful method. Its thinness, pliability, and ability to maintain a consistent volume and surface area are suitable for intraoral reconstruction, and the flap conforms well to the contours of the oral cavity [1]. Free radial forearm flaps could be easily folded to repair the skin and mucosa.…”

“…With only five individual cases previously reported in the literature [1,2], the simultaneous dislocation of the carpometacarpal (CMC) and metacarpophalangeal (MCP) joints of the thumb without a fracture, also known as the floating thumb metacarpal, is an extremely rare injury.…”