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.