Complications and functional outcomes following complex oropharyngeal reconstruction

Background. We sought to evaluate postoperative complications and functional outcomes in patients who underwent oropharyngeal reconstruction after oncologic resection. Methods. The evaluation constituted a retrospective review of 65 patients who underwent microvascular free flap (85%) and/or pectoralis pedicled flap (18%) oropharyngeal reconstruction after composite resection for advanced oropharyngeal squamous cell carcinoma. Results. Perioperative mortality was 1.5%. Overall, 29 patients (45%) experienced surgical or medical complications; however, only 2 patients (3%) required operative intervention. The flap success rate was 100%. Eighty-six percent of patients were decannulated, 34% were able to meet all of their nutritional needs orally, and 69% attained >80% speech intelligibility. Preoperative swallowing impairment was associated with postoperative feeding tube dependence (p = .006). Conclusions. Microvascular free flap and/or pectoralis pedicled flap reconstruction of extensive oropharyngeal defects is safe and reliable, even with advanced disease. Although most patients achieved decannulation and functional speech, almost two thirds remained at least partially feeding tube dependent.