Functional soft palate reconstruction

The excision of oropharyngeal carcinoma of more than 50% of the soft palate followed by static reconstruction may result in functional deficits, including velopharyngeal insufficiency, swallowing, and speech difficulties. We describe a functional soft palate reconstruction technique aimed at restoring aeromechanical and acoustic functions, enabling swallowing without nasal regurgitation and speech with low nasalance.

We developed a new operative technique, using muscle transfer and a free flap to create a dynamic reconstruction. To prove the distinct nerve innervation of the two digastric bellies and the feasibility of the technique, we first performed an anatomical study, and then implemented the technique in our clinic. The surgical technique included transfer of the anterior and posterior bellies of the digastric muscle in association with a folded radial forearm free flap. A retrospective analysis of patients who underwent this soft palate functional reconstruction after cancer resection between 2007 and 2017 was performed, and a subjective analysis of nasalance and swallowing was done to evaluate the functional outcomes.

Eight patients (six males, two females) with a mean age of 56 years (range 43-69) who were affected by oropharynx carcinoma (stage T1-3) infiltrating the soft palate were included. Analysis of the reconstruction showed that seven of the eight patients had satisfactory swallowing function, and all patients were able to speak in an understandable manner with minimal nasalance.

Our surgical approach provided a functional reconstruction with outcomes close to normality, making it a suitable technique for patients with large soft palate defects.