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Mandibular and palatal reconstruction in patients with head and neck cancer

Authors
Barry L Wenig, MD, MPH
Michael R Zenn, MD, FACS
Section Editors
Bruce E Brockstein, MD
Marvin P Fried, MD, FACS
Deputy Editor
Michael E Ross, MD

INTRODUCTION

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 [1].

Primary reconstruction can rapidly restore anatomy and function and decrease the number of operations and duration of hospitalization [2]. 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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Literature review current through: Nov 2016. | This topic last updated: Tue Sep 08 00:00:00 GMT 2015.
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