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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Rivista Italiana di Chirurgia Maxillo-Facciale 2005 January-December;16(1-3):43-50
Microsurgical reconstruction of oropharynx, lingual and inferior alveolar nerves
Biglioli F. 1, Frigerio A. 1, Rezzonico A. 2, Autelitano L. 1, Rabbiosi D. 1, Carota F. 1, Brusati R. 1
1 Chair and Division of Maxillofacial Surgery San Paolo Hospital, Milan University, Milan, Italy
2 Region Centre of Cleft Lip and Palate San Paolo University Hospital, Milan, Italy
Aim. Oncological surgery of soft palate and tonsillar fossa often involves resection of lingual and inferior alveolar nerves. Forearm free flap is commonly used to reconstruct this region; moreover, it contains the lateral antebrachial nerve that can be used as interposition graft to reconstruct lingual or inferior alveolar nerves. When both nerves are resected, great auricular nerve can be grafted, too.
Methods. Between April 1995 and March 2004, 8 patients were operated on for tonsillar fossa and soft palate carcinoma and primary reconstruction with forearm free flap was accomplished. Nerve reconstruction by interposition nerve grafts was accomplished. Morpho-functional results were analysed and compared to current literature.
Results. Objective sensitivity and logopedic test and subjective patients’ satisfaction questionnaires showed that patients had a discrete recovery of oral functions.
Conclusion. Forearm free flap is the first choice in microsurgical reconstruction of soft palate and tonsillar fossa. It can be shaped and folded to reconstruct the three dimensions of resected region, preserving soft palate function and velo-pharyngeal competence. When lingual and/or inferior alveolar nerve are resected for oncological reasons, interposition nerve grafts with lateral antebrachial or great auricolar nerves allow to restore their function, with better results for patients’ quality of life.