CC BY-NC-ND 4.0 · Laryngorhinootologie 2024; 103(S 01): S3-S27
DOI: 10.1055/a-2181-9088
Referat

Interdisciplinary plastic and reconstructive surgery of head and neck squamous cell carcinomas

Article in several languages: deutsch | English
S. Remmert
1   Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie Helios St. Anna-Klinik, Duisburg-Huckingen
,
F. Sack
1   Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie Helios St. Anna-Klinik, Duisburg-Huckingen
,
S. Hasenberg
1   Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie Helios St. Anna-Klinik, Duisburg-Huckingen
,
M. Lehnhardt
2   Universitätsklinik Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG Universitätsklinikum Bergmannsheil Bochum
,
Y. Steubing
2   Universitätsklinik Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG Universitätsklinikum Bergmannsheil Bochum
,
F. Puscz
2   Universitätsklinik Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG Universitätsklinikum Bergmannsheil Bochum
› Author Affiliations

Abstracts

Squamous cell carcinomas are the most common malignancies in the oral cavity, pharynx, and larynx. Even in the age of the most modern drug treatment methods, radical resection of these tumors is and currently remains the therapeutic gold standard. The loss of anatomical structures associated with surgery inevitably increases the functional deficits caused by the tumor itself. In this context, the extent of functional deficits is largely determined by the extent of resection. Complete organ resections, such as glossectomy, complete palate resection, laryngectomy, or transverse pharyngo-laryngectomy, lead to severe functional deficits, such as swallowing disturbances with life-threatening aspiration and articulation disorders up to the inability to speak. With the help of plastic reconstructive surgery, the lost tissue can be replaced and the specific functions of the upper aerodigestive tract can be preserved or restored.

In recent decades, reconstructive surgical procedures have developed enormously in the treatment of malignant tumors of the head and neck. In order to make optimal use of them, a comprehensive, interdisciplinary therapy concept is a prerequisite for positive oncological and functional outcome. In addition to general medical and social parameters, surgical parameters play a crucial role in the choice of the reconstruction method. The extent to which the surgical measures must be interdisciplinary depends on the localization of the defects in the head and neck region and on the type of replacement tissue required. Here, the expertise of plastic surgery, oral and maxillofacial surgery, and abdominal surgery comes into play in particular. The use of different tissues, the combination of different grafts and flaps, or the preforming of donor regions allow reconstructions far beyond the level of simply restoring surface integrity. The functional results and thus the quality of life of patients after surgical therapy of extensive tumors of the mentioned localizations depend decisively on the type of reconstruction. Therefore, in the following review, special emphasis 1 be placed on the choice of reconstruction method and reconstruction technique for tissue loss after resections of HNSCC.



Publication History

Article published online:
02 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 Haughey BH. Tongue reconstruction: concepts and practice. Laryngoscope 1993; 103: 1132-1141
  • 2 Hirano M, Kuroiwa Y, Tanaka S, Matsuoka H, Sato K, Yoshida T. Dysphagia following various of surgical resection for oral cancer. Ann Otol Rhinol Laryngol 1992; 101: 138-141
  • 3 Maier H, Schwetschke O, Weidauer H. Verminderte Aspiration nach ausgedehnten tumorchirurgischen Eingriffen im Bereich von Mundhöhle und Rachen durch Kehlkopfhochzug. HNO 1992; 40: 472-475
  • 4 Shestak KC, Myers EN, Ramasastry SS, Jones NF, Johnson JT. Vascularized free-tissue transfer in head and neck surgery. Am J Otolaryngol 1993; 14: 148-154
  • 5 Tiwari R, Karim AB, Greven AJ, Snow GB. Total glossectomy with laryngeal preservation. Arch Otolaryngol Head Neck Surg 1993; 119: 945-949
  • 6 Urken ML, Moscoso JF, Lawson W, Biller HF. A systematic approach to the functional reconstruction of the oral cavity following partial and total glossectomy. Arch Otolaryngol Head Neck Surg 1994; 120: 589-601
  • 7 Effron MZ, Johnson JT, Myers EN, Curtin H, Beery Q, Sigler B. Advanced carcinoma of the tongue. Management by total glossectomy without laryngectomy. Arch Otolaryngol 1981; 107: 694-697
  • 8 Keyserlingk JR, de Francesco J, Breach N, Rhys-Evans P, Stafford N, Mott A. Recent experience with reconstructive surgery following major glossectomy. Arch Otolaryngol Head Neck Surg 1989; 115: 331-338
  • 9 Myers E. The role of total glossectomy in the management of cancer of the oral cavity. Otolaryngol Clin North Am 1972; 5: 343-355
  • 10 Sultan MR, Coleman JJ. Oncologic and functional considerations of total glossectomy. Am J Surg 1989; 158: 297-302
  • 11 Weber RS, Ohlms L, Bowman J, Jacob R, Goepfert H. Functional results after total or near total glossectomy with laryngeal preservation. Arch Otolaryngol Head Neck Surg 1991; 117: 512-515
  • 12 Maier H, Zöller J, Tiwari RM. M. masseter- Lappen und Wangenschleimhauttranspositionslappen zur Rekonstruktion der dorsalen Mundhöhle und des Oropharynx. Laryngo-Rhino-Otol 1991; 70: 538-541
  • 13 Maier H, Zöller J. Kombination von Velopharyngoplastik und Wangenschleimhauttranspositionslappen zur primären Rekonstruktion des weichen Gaumens. HNO 1992; 40: 306-309
  • 14 Lauciello FR, Vergo T, Schaaf NG, Zimmerman R. Prosthodontic and speech rehabilitation after partial and complete glossectomy. J Prosthet Dent 1980; 43: 204-211
  • 15 Michiwaki Y, Ohno K, Imai S, Yamashita Y, Suzuki N, Yoshida H, Michi K. Functional effects of intraoral reconstruction with a free radial forearm flap. J Craniomaxillofac Surg 1990; 18: 164-168
  • 16 Bates GJ, McFeeter L, Coman W. Pharyngolaryngectomy and voice restoration. Laryngoscope 1990; 100: 1025-1026
  • 17 Harrison DF, Thompson AE. Pharyngolaryngoesophagectomy with pharyngogastric anastomosis for cancer of the hypopharynx: review of 101 operations. Head Neck Surg 1986; 8: 418-428
  • 18 Maniglia AJ, Leder SB, Goodwin WJ, Sawyer R, Sasaki CT. Tracheogastric puncture for vocal rehabilitation following total pharyngolaryngoesophagectomy. Head Neck 1989; 11: 524-527
  • 19 Mendelsohn M, Morris M, Gallagher R. A comparative study of speech after total laryngectomy and total laryngopharyngectomy. Arch Otolaryngol Head Neck Surg 1993; 119: 508-510
  • 20 Schechter GL, Baker JW, Gilbert DA. Functional evaluation of pharyngoesophageal reconstructive techniques. Arch Otolaryngol Head Neck Surg 1987; 113: 40-44
  • 21 Bleach N, Perry A, Cheesman A. Surgical voice restoration with the Blom-Singer prosthesis following Laryngopharyngoesophagectomy and pharyngogastric anastomosis. Ann Otol Rhinol Laryngol 1991; 100: 142-147
  • 22 Aguilar NV, Olson ML, Shedd DP. Rehabilitation of deglutition problems in patients with head and neck cancer. Am J Surg 1979; 138: 501-507
  • 23 Conley J. Concepts in Head and Neck Surgery. Stuttgart: Thieme; 1970
  • 24 Summers GW. Physiologic problems following ablative surgery of the head and neck. Otolaryngol Clin North Am 1974; 7: 217-250
  • 25 Logeman JA, Bytell DE. Swallowing disorders in three types of head and neck surgical patients. Cancer 1979; 44: 1095-1105
  • 26 McConnel FM. Analysis of pressure generation and bolus transit during pharyngeal swallowing. Laryngoscope 1988; 98: 71-78
  • 27 Michiwaki Y, Schmelzeisen R, Hacki T, Michi K. Articulatory function in glossectomized patients with immediate reconstruction using a free jejunum flap. J Craniomaxillofac Surg 1992; 20: 203-210
  • 28 Walther EK, Rödel R, Deroover M. Rehabilitation der Schluckfunktion bei Patienten mit Pharynxkarzinomen. Laryngo-Rhino-Otol 1990; 69: 360-368
  • 29 Zöller J, Maier H. Intraoral cheek transposition flap for primary reconstruction of the soft palate. Int J Oral Maxillofac Surg 1992; 21: 156-159
  • 30 Salibian AH, Allison GR, Strelzow VV, Krugman ME, Rappaport I, McMicken BL, Etchepare TL. Secondary microvascular tongue reconstruction: functional results. Head Neck 1993; 15: 389-397
  • 31 McConnell FM, Teichgraeber JF, Adler RK. A comparison of three methods of oral reconstruction. Arch Otolaryngol Head Neck Surg 1987; 113: 496-500
  • 32 Hannig C, Wuttge-Hannig A, Hörmann M, Herrmann IF. Kinematographische Untersuchungen des Pathomechanismus der Aspirationspneumonie. Rofo 1989; 150: 260-267
  • 33 Sessions DG, Zill R, Schwartz SL. Deglutition after conservation surgery for cancer of the larynx and hypopharynx. Otolaryngol Head Neck Surg 1979; 87: 779-796
  • 34 Bakamjian V, Littlewood M. Cervical skin flaps for intraoral and pharyngeal repair following cancer surgery. Br J Plast Surg 1964; 17: 191-210
  • 35 Millard DR. Forehead flaps in immediate repair of head, face and jaw. Am J Surg 1964; 108: 508-513
  • 36 McGregor IA. The temporal flap in intraoral cancer. Its use in repairing the post excisional defect. Br J Plast Surg 1963; 16: 318-335
  • 37 Ariyan S. The pectoralis major myocutaneous flap: A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979; 63: 73-81
  • 38 Beak SM, Biller HF, Krespi YP, Lawson W. The pectoralis major myocutaneous island flap for reconstruction of the head and neck. Head Neck Surg 1979; 1: 293-300
  • 39 Ariyan S. One-stage reconstruction for defects of the mouth using a sternomastoid myocutaneous flap. Plast Reconstr Surg 1979; 63: 618-625
  • 40 Olivari N. The latissimus flap. Br J Plast Surg 1976; 29: 126-128
  • 41 Seidenberg B, Rosznak SS, Hurwitt ES. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg 1959; 149: 162-171
  • 42 Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Plast Reconstr Surg 1979; 64: 595-604
  • 43 Yang GF, Chen PJ, Gao YZ, Liu XY, Li J, Jiang SX, He SP. Forearm free skin flap transplantation: a report of 56 cases. Chin Med J 1981; 61: 139-141
  • 44 Song R, Song Y, Yu Y, Song Y. The upper arm free flap. Clin Plast Surg 1982; 9: 27-35
  • 45 Dos Santos LF. The vascular anatomy and dissection of the free scapular flap. Plast Reconstr Surg 1984; 73: 599-604
  • 46 Nassif TM, Vidal L, Bovet JL, Baudet J. The parascapular flap: a new cutaneous microsurgical free flap. Plast Reconstr Surg 1982; 69: 591-600
  • 47 Aviv JE, Keen MS, Rodriguez HP, Stewart C, Gund E, Blitzer A. Bilobed radial forearm free flap for functional reconstruction of near-total glossectomy defects. Laryngoscope 1994; 104: 893-900
  • 48 Urken ML, Biller HF. A new bilobed design for the sensate radial forearm flap to preserve tongue mobility following significant glossectomy. Arch Otolaryngol Head Neck Surg 1994; 120: 26-31
  • 49 Chow LQM. Head and Neck Cancer. N Engl J Med 2020; 382: 60-72
  • 50 Erdmann F, Spix C, Katalinic A, Christ M, Folkerts J, Hansmann J, Kranzhöfer K, Kunz B, Manegold K, Penzkofer A, Treml K, Vollmer G, Weg-Remers S, Barnes B, Buttmann-Schweiger N, Dahm S, Fiebig J, Franke M, Schönfeld I, Haberland J, Imhoff M, Kraywinkel K, Starker A, von Berenberg-Gossler P, Wienecke A. Krebs in Deutschland für 2017/2018. 13. Ausgabe. Robert Koch-Institut (Hrsg) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Hrsg). Berlin 2021; 2021: 1-168
  • 51 Johnson DE, Burtness B, Leemans CR, Lui VWY, Bauman JE, Grandis JR. Head and neck squamous cell carcinoma. Nat. Rev. Dis. Prim. 2020; 6: 92
  • 52 Chaturvedi AK, Engels EA, Pfeiffer RM, Hernandez BY, Xiao W, Kim E, Jiang B, Goodman MT, Sibug-Saber M, Cozen W, Liu L, Lynch CF, Wentzensen N, Jordan RC, Altekruse S, Anderson WF, Rosenberg PS, Gillison ML. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 2011; 29: 4294-4301
  • 53 Parker V. Antony van Leeuwenhoek. Bull Med Libr Assoc 1965; 53: 442-447
  • 54 Hong JPJ, Song S, Suh HSP. Supermicrosurgery: Principles and applications. J Surg Oncol 2018; 118: 832-839
  • 55 Hirche C, Engel H, Seidenstuecker K, Taeger C, Machens HG, Frick A, Harder Y. [Lympho-reconstructive microsurgery for secondary lymphedema: Consensus of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels (DAM) on indication, diagnostic and therapy by lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT)]. Handchir Mikrochir Plast Chir 2019; 51: 424-433
  • 56 Innocenti M, Malzone G, Menichini G. First-in-Human Free Flap Tissue Reconstruction Using a Dedicated Microsurgical Robotic Platform. Plast Reconstr Surg 2023; 151: 1078-1082
  • 57 van Mulken TJM, Schols RM, Scharmga AMJ, Winkens B, Cau R, Schoenmakers FBF, Qiu SS, van der Hulst RRWJ. First-in-human robotic supermicrosurgery using a dedicated microsurgical robot for treating breast cancer-related lymphedema: a randomized pilot trial. Nat Commun 2020; 11: 757
  • 58 Haynes WI, de Boutray M, Kennel T, Boetto J. Osteocutaneous radial forearm free flap for anterior cranial base reconstruction: Technical note. Neurochirurgie 2021; 67: 606-610
  • 59 Wong CH, Wei FC. Anterolateral thigh flap. Head Neck 2010; 32: 529-540
  • 60 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37: 149-159
  • 61 Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg 1989; 42: 260-262
  • 62 Sayyed AA, Abu El Hawa AA, Huffman SS, Deldar R, Bekeny JC, Attinger CE, Fan KL, Evans KK. Vascular Anatomy of the Anteromedial Thigh Flap: A Systematic Review. Plast Reconstr Surgery Glob Open 2022; 10: e4546
  • 63 Koshima I, Fukuda H, Soeda S. Free combined anterolateral thigh flap and vascularized iliac bone graft with double vascular pedicle. J Reconstr Microsurg 1989; 1989: 55-61
  • 64 Tzouma G, Kopanakis NA, Tsakotos G, Skandalakis PN, Filippou D. Anatomic Variations of the Deep Femoral Artery and Its Branches: Clinical Implications on Anterolateral Thigh Harvesting. Cureus 2020; 12: e7867
  • 65 Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 1975; 55: 533-544
  • 66 Gilbert A. Free vascularized bone grafts. Int Surg 1981; 66: 27-31
  • 67 Remmert SM, Majocco AM, Sommer KD, Ahrens KH, Weerda HG. Neue Methode der Zungenrekonstruktion mit neurovaskulären infrahyoidalen Muskelfaszienlappen. Laryngo-Rhino-Otol 1994; 73: 198-201
  • 68 Remmert SM, Sommer KD, Majocco AM, Weerda HG. The neurovascular infrahyoid muscle flap: a new method for tongue reconstruction. Plast Reconstr Surg 1997; 99: 613-618
  • 69 Bootz F. Der freie Unterarmlappen zur Defektdeckung im Pharynx und Mundhöhlenbereich. HNO 1988; 36: 462-466
  • 70 Bootz F, Becker D, Fliesek J. Funktionelle Ergebnisse und Überlebenswahrscheinlichkeiten bei Tumorpatienten nach Rekonstruktion in Mundhöhle und Oropharynx mit Hilfe des mikrovaskularisierten radialen Unterarmlappens. HNO 1993; 41: 380-384
  • 71 Drommer RB. Die Rekonstruktion von großen Mundhöhlendefekten mit Hilfe des mikrovaskulär anastomosierten forearm flap. Schweiz Monatsschr Zahnmed 1984; 96: 774-778
  • 72 Remmert S, Sommer K, Krappen S, Gehrking E. Plastische Rekonstruktion von Defekten im Bereich des weichen Gaumens – funktionelle und onkologische Aspekte. Laryngo-Rhino-Otol 1997; 76: 169-177
  • 73 Remmert S, Müller G, Weerda H. Revaskularisierte überlange Jejunumsegmente in der einzeitigen Wiederherstellung von Stimm- und Sprechfunktion nach totaler Laryngopharyngektomie. HNO 1993; 41: 485-490
  • 74 Dietz A. Kopf-Hals-Tumoren – Therapie des Larynx/Hypopharynxkarzinoms unter besonderer Berücksichtigung des Larynxorganerhalts. Bremen: Unimed; 2008
  • 75 Lange J, Siewert RD. (Hrsg). Esophageal carcinoma state of the art. Berlin: Springer; 2000
  • 76 Remmert S. Moderne Rekonstruktionsverfahren zur Wiederherstellung der Stimm- und Schluckfunktion nach ausgedehnten Tumorresektionen im oberen Aerodigestivtrakt. Aachen: Shaker; 2000
  • 77 Satorius A, Succo G, Mioli P, Merlino G. Reconstruction of the pharynx and cervial esophagus using ileocolic free autocraft. Am J Surg 1999; 178: 316-322
  • 78 Remmert S. Expertise Funktionelle Wiederherstellung der oberen Luft- und Speisewege. Stuttgart: Thieme; 2015. DOI: 10.1055/b-005-143303