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Reconstruction of TORS oropharyngectomy defects with the nasoseptal flap via transpalatal tunnel

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Abstract

The nasoseptal flap (NSF) has been described as reconstructive option for soft palate defects following transoral robotic surgery (TORS). As described, this technique is does not provide adequate coverage of the lateral oropharyngeal wall, parapharyngeal space, exposed vessels, or exposed mandibular bone. The NSF for TORS reconstruction has been limited to soft palate reconstruction, given the limitations on length when passed via the nasopharynx. In this article, we describe (1) a novel technique for TORS reconstruction using direct transposition of the ipsilateral NSF into the oropharynx via a transpalatal tunnel at the hard–soft palate junction, and (2) its use in select patients.

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Author information

Correspondence to Meghan T. Turner.

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Conflict of interest

Robert L. Ferris, MD, PhD has the following disclosures: Amgen (Advisory Board); Astra-Zeneca/MedImmune (Advisory Board, Clinical trial, Research Funding); Bristol-Myers Squibb (Advisory board, Clinical trial, Research funding); EMD Serono (Advisory Board); Benetic (Advisory Board); Lilly (Advisory Board); Merck (Advisory Board, Clinical trial); Pfizer (Advisory Board); VentiRx Pharmaceuticals (Research funding). Meghan T. Turner, Mathew Geltzeiler, MD, W. Greer Albergotti, MD, Umamaheswar Duvvuri, MD, PhD, Seungwon Kim, MD, Eric W. Wang, MD, declare that they have no conflicts of interest. The NSF provides excellent local flap reconstruction for lateral oropharyngectomy defects following TORS. This is the first description of a laterally-based, pedicled NSF design utilization for ICA coverage during transoral surgery. This required minimal additional surgical time and was effective in preventing acute or delayed ICA bleeding. Additionally, it postoperative healing. Although reported here only during TORS oropharyngectomy, it is intuitive that this technique also applies to transoral laser microsurgery.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study per institutional protocols.

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Turner, M.T., Geltzeiler, M., Albergotti, W.G. et al. Reconstruction of TORS oropharyngectomy defects with the nasoseptal flap via transpalatal tunnel. J Robotic Surg (2019) doi:10.1007/s11701-019-00984-5

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Keywords

  • Nasoseptal flap (NSF)
  • Transoral robotic surgery (TORS)
  • Robotic oropharyngectomy
  • Robotic-assisted reconstruction
  • Oropharyngeal reconstruction