[CT and MRI of small intestine interposition after oropharyngeal tumor resection]

Freely transplanted, microvascularly anastomosed jejunal patches can be used to cover soft tissue defects in the oral cavity or oropharynx after the resection of malignant tumors. Even a patch without complications or alteration from tumor recurrence is morphologically diverse. Therefore it is difficult to distinguish between malignant and benign alterations, and knowledge of the possible morphological spectrum and the significance of an alteration is of practical interest. Computed tomography (CT; n = 30) and magnetic resonance imaging (MRI; n = 13) were used for follow-up examinations in patients who had an operative reconstruction with a jejunal patch. Three parts of a patch were differentiated with both imaging modalities: the region of the anastomosis, the mesenterial fatty tissue and the intestinal wall. The morphology of the patches correlated with clinical findings in the following cases. The patches were identified satisfactorily by CT and MRI. The appearance of patches without complications was influenced by a variable degree of fibrosis and by persistent intestinal folds. Recurrent tumors only infiltrated the margins of the patches. Destructive alterations in the patches were always less severe than those in the original orofacial soft tissue. Postoperative follow-up examinations with CT and MRI are particularly important when tumor recurrences spread under a patch, since these tumors are invisible in the clinical examinations. CT was advantageous in demonstrating osseous alterations and showed less loss of image quality in patients for whom the implantation of multiple metallic hardware during the operation had been necessary.