de Almeida John R, Park Richard Chan Woo, Villanueva Nathaniel L, Miles Brett A, Teng Marita S, Genden Eric M
Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York.
Head Neck. 2014 Jul;36(7):934-41. doi: 10.1002/hed.23353. Epub 2014 May 19.
Transoral techniques for oropharyngeal tumors, such as transoral robotic surgery (TORS) and transoral laser microsurgery, require new reconstructive considerations.
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.
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).
The classification system for transoral oropharyngeal defects maps defects into 4 classes and guides the reconstructive thought process.
口咽肿瘤的经口技术，如经口机器人手术（TORS）和经口激光显微手术，需要新的重建考量。
对92例行TORS的患者的缺损进行分类，分为4类。遵循重建算法，评估围手术期结果和并发症。47例患者术后完成了MD安德森吞咽量表（MDADI）和改良的腭咽闭合不全生活质量量表（VPIQL）。
最常见的重建方法包括带局部皮瓣的腭咽成形术（39%）、单纯局部皮瓣（25%）或二期愈合（20%）。更严重的缺损（III类和IV类缺损）更常需要区域皮瓣和游离皮瓣。4类缺损的MDADI评分或VPIQL评分无显著差异。只有辅助放疗是吞咽功能差的预测因素（p = 0.02）。
经口口咽缺损分类系统将缺损分为4类，并指导重建思维过程。
