Reconstruction of a Total Soft Palatal Defect Using a Folded Radial Forearm Free Flap and Palmaris Longus Tendon Sling
Open Access
- 1 January 2012
- journal article
- Published by Georg Thieme Verlag KG in Archives of Plastic Surgery
- Vol. 39 (01), 25-30
- https://doi.org/10.5999/aps.2012.39.1.25
Abstract
Background The soft palate functions as a valve and helps generate the oral pressure required for normal speech resonance. Speech problems and nasal regurgitation can result from a soft palatal defect. Reduction of the size of the velopharyngeal orifice is required to compensate for the lack of mobility in a reconstructed soft palate. We suggest a large volume folded free flap for reduction of the caliber and a palmaris longus tendon sling for suspension of the reconstructed palate. Methods Six patients had total soft palate resection for tonsillar cancer and reconstruction with a large volume folded radial forearm free flap combined with a palmaris longus sling. A single surgeon and speech therapist examined the patients with three standardized speech assessment tools: nasometer test, consonant articulation test, and speech acuity test performed for speech evaluation. Results Mean nasalance score was 76.20% for sentences with nasal sounds and 43.60% for sentences with oral sounds. Hypernasality was seen for oral sound sentences. The mean score of the picture consonant articulation test was 84% (range, 63% to 100%). The mean score of the speech acuity test was 5.84 (range, 5 to 6). These mean ratings represent a satisfactory level of speech function. Conclusions The large volume folded free flap with a palmaris longus tendon sling for total soft palate reconstruction resulted in satisfactory prognosis for speech despite moderate hypernasality.This publication has 10 references indexed in Scilit:
- Radial forearm‐palmaris longus tenocutaneous free flap; implication in the repair of the moderate‐sized postoncologic soft palate defectHead & Neck, 2009
- Functional soft palate reconstruction: A comprehensive surgical approachHead & Neck, 2008
- Speech outcomes after soft palate reconstruction with the soft palate insufficiency repair procedureHead & Neck, 2008
- The folded radial forearm flap in soft-palate and tonsillary fossa reconstruction: technical noteInternational Journal of Oral & Maxillofacial Surgery, 2008
- Functional Benefit after Modification of Radial Forearm Free Flap for Soft Palate ReconstructionClinical and Experimental Otorhinolaryngology, 2008
- Speech and swallowing following radial forearm flap reconstruction of major soft palate defectsBritish Journal of Plastic Surgery, 2005
- Functional Outcomes following Palatal Reconstruction with a Folded Radial Forearm Free FlapEar, Nose & Throat Journal, 2004
- Functional Outcomes After Primary Oropharyngeal Cancer Resection and Reconstruction With the Radial Forearm Free FlapThe Laryngoscope, 2003
- Standardization of Flap Design for Oropharyngeal Reconstruction after Cancer Ablation SurgeryYonsei Medical Journal, 2003
- Functional outcome in soft palate reconstruction using a radial forearm free flap in conjunction with a superiorly based pharyngeal flapHead & Neck, 1997