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Functional considerations in oral cavity reconstruction

Pipkorn, Patrika; Rosenquist, Kelseya; Zenga, Josephb

Current Opinion in Otolaryngology & Head and Neck Surgery: October 2018 - Volume 26 - Issue 5 - p 326–333
doi: 10.1097/MOO.0000000000000474

Purpose of review The treatment of oral cavity cancer may impair speech and swallowing function. Optimizing posttreatment function may lead to significant improvement of quality of life.

Recent findings Although oncologic control remains the main goal of treatment for oral cavity cancer, posttreatment function for surviving patients has over the last decades been recognized as an important secondary outcome. Reconstruction of oral cavity defects range from primary closure to advanced microvascular reconstruction, including multiple tissue types. Free flap reconstruction has greatly enhanced the ability to tailor transferred tissue to specific defects. In this review, we describe recent findings in reconstruction of tongue defects, including data from perforator flaps. We also summarize recent evidence regarding reinnervated flaps.

Summary When vascularized tissue is needed, it remains unclear how the reconstructive choice impacts postoperative outcome, although in many situations it appears to be dominated by the donor site morbidity rather than the reconstructive technique. Despite numerous case series, the functional impact of motor and sensory reinnervation in vascularized tissue remains unknown. Although perforator flaps have emerged as a promising flap option, with favorable donor site morbidity, their ultimate impact on functional outcomes remains unclear, whereas the success rate appears to be lower than traditional flaps.

aDepartment of Otolaryngology, Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri

bMassachusetts Eye and Ear Infirmary, Harvard School of Medicine, Boston, Massachusetts, USA

Correspondence to Patrik Pipkorn, MD, Department of Otolaryngology, Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8057, St. Louis, MO 63110, USA. Tel: +1 314 362 6599; fax: +1 314 362 7522; e-mail:

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