Reconstructive algorithm and classification system for transoral oropharyngeal defects

BACKGROUND: Transoral techniques for oropharyngeal tumors, such as transoral robotic surgery (TORS) and transoral laser microsurgery, require new reconstructive considerations. METHODS: Defects from 92 patients undergoing TORS were classified into 4 classes. A reconstruction algorithm was followed. Perioperative outcomes and complications were assessed. Forty-seven patients completed the MD Anderson Dysphagia Inventory (MDADI) swallowing questionnaire and a modified Velopharyngeal Insufficiency Quality of Life (VPIQL) questionnaire postoperatively. RESULTS: The most common reconstructions involved velopharyngoplasties with local flaps (39%), local flaps alone (25%), or secondary healing (20%). More advanced defects (class III and IV defects) required regional and free flaps more often. No significant differences were found in MDADI scores or VPIQL scores among the 4 defect classes. Only adjuvant radiotherapy was a predictor of poor swallowing (p = .02). CONCLUSION: The classification system for transoral oropharyngeal defects maps defects into 4 classes and guides the reconstructive thought process.