Mandibular and palatal reconstruction in patients with head and neck cancer
- Barry L Wenig, MD, MPH
Barry L Wenig, MD, MPH
- Professor and Director
- Otolaryngology-Head and Neck Surgery
- Michigan State University College of Human Medicine
- Michael R Zenn, MD, FACS
Michael R Zenn, MD, FACS
- Associate Professor
- Plastic and Reconstructive Surgery
- Duke University Medical Center
- Section Editors
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
Carcinoma of the head and neck can be treated and potentially cured by surgery, radiation therapy (RT), or a combined modality approach, which may also incorporate chemotherapy. The defects caused by surgical excision can cause significant problems in airway management, mastication, deglutition, speech, and cosmesis. In addition, RT has significant adverse effects upon wound healing that can complicate surgical management. (See "Management of late complications of head and neck cancer and its treatment".)
The goal of surgical reconstruction is to restore presurgical function and cosmesis. Optimization of the outcome of surgical reconstruction requires a team approach and should include speech pathology, physical therapy, and psychosocial support as appropriate.
The basic elements of mandibular reconstruction and palatal reconstruction will be reviewed here. The management of maxillary defects are discussed separately, as is rehabilitation for speech and swallowing defects. (See "Management of acquired maxillary and hard palate defects" and "Speech and swallowing rehabilitation of the patient with head and neck cancer".)
TIMING OF RECONSTRUCTION
Reconstruction may be primary (performed at the time of resection of the tumor) or secondary (performed as a separate procedure after resection, or to repair a defect left by an ulcerative tumor treated by primary radiation). Primary reconstruction has become the standard of care for most patients .
●Primary reconstruction can rapidly restore anatomy and function and decrease the number of operations and duration of hospitalization . Because the head and neck patient may have a limited life span and significant premorbid conditions, rapid recovery and decreased hospital stay are important considerations. However, the possibility of infection with intraoral contamination of the graft is always of concern.
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- TIMING OF RECONSTRUCTION
- MANDIBULAR RECONSTRUCTION
- Free tissue transfer
- Pedicled vascularized grafts
- Nonvascularized autogenous bone grafts
- Donor sites
- Reconstruction plates
- SOFT PALATE RECONSTRUCTION
- Function of the palate
- Treatment of palatal defects
- - Obturators
- - Reconstructive flaps