The Nasoseptal Flap for Reconstruction of Lateral Oropharyngectomy Defects: A Clinical Series

Meghan T. Turner, Mathew N. Geltzeiler, Jad Ramadan, Jessica M. Moskovitz, Robert L. Ferris, Eric W. Wang, Seungwon Kim

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objectives/Hypothesis: To study use of the nasoseptal flap (NSF) to reconstruct lateral transoral robotic surgery (TORS) oropharyngectomy defects. Study Design: Retrospective case series. Methods: A clinical series of six patients undergoing NSF reconstruction of lateral TORS oropharyngectomy defects was retrospectively studied. All patients underwent TORS for the treatment of intermediate-risk human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma of the lateral pharyngeal wall between January and June 2017. All patients underwent NSF reconstruction of lateral TORS defects with retrospective analysis of outcomes and complications. Results: Six patients underwent NSF reconstruction of lateral TORS defects. Operative times decreased from 180 minutes to 90 minutes over the study period. There were two cases of partial flap dehiscence and partial necrosis. There were no major donor site complications. All patients had temporary nasal obstruction and crusting. Two experienced temporary aural fullness. In all patients, the lateral wall was mucosalized in 1–3 weeks. Cephalometric analysis of preoperative imaging revealed that patients with high-arched palates (>3 cm) and defect lengths that are longer than NSF flap lengths are poor candidates for this technique. Conclusions: This NSF is a vascularized, locoregional rotational flap that can reconstruct lateral TORS defects in salvages cases or those where the parapharyngeal carotid or mandibular bone are exposed. Postoperative morbidity is limited to temporary nasal dyspnea, aural fullness, and crusting. Preoperative imaging can determine which patient will have successful defect coverage. Level of Evidence: 4 Laryngoscope, 132:53–60, 2022.

Original languageEnglish (US)
Pages (from-to)53-60
Number of pages8
JournalLaryngoscope
Volume132
Issue number1
DOIs
StatePublished - Jan 2022

Keywords

  • Nasoseptal flap
  • oropharyngeal reconstruction
  • robotic oropharyngectomy
  • robotic-assisted reconstruction
  • transoral robotic surgery

ASJC Scopus subject areas

  • Otorhinolaryngology

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