Infrahyoid flap in oropharyngeal reconstruction following carcinoma resection: A study of 6 patients and literature review

Infante‑Cossio,Pedro; Gonzalez‑Cardero,Eduardo; Lopez‑Martos,Ricardo; Nuñez‑Vera,Victoria; Olmos‑Juarez,Erika; Ruiz‑Moya,Alejandro; Haro‑Luna,Juan‑Jose; Torres‑Carrranza,Eusebio

doi:10.3892/ol.2016.4429

Infrahyoid flap in oropharyngeal reconstruction following carcinoma resection: A study of 6 patients and literature review

Authors:
- Pedro Infante‑Cossio
- Eduardo Gonzalez‑Cardero
- Ricardo Lopez‑Martos
- Victoria Nuñez‑Vera
- Erika Olmos‑Juarez
- Alejandro Ruiz‑Moya
- Juan‑Jose Haro‑Luna
- Eusebio Torres‑Carrranza
View Affiliations

Affiliations: Department of Oral and Maxillofacial Surgery, Virgen Del Rocío University Hospital, University of Seville, Seville, Seville 41013, Spain, Department of Plastic and Reconstructive Surgery, Virgen Del Rocío University Hospital, University of Seville, Seville, Seville 41013, Spain, Department of Oral and Maxillofacial Surgery, Santa Lucía Hospital, Cartagena, Murcia 30202, Spain
Published online on: April 7, 2016 https://doi.org/10.3892/ol.2016.4429
Pages: 3493-3500

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study aimed to describe the techniques used and the results obtained with the infrahyoid flap for the reconstruction of medium‑sized oropharyngeal defects following resection for advanced squamous cell cancer. During a period of 1 year, six patients with oropharyngeal defects were reconstructed using the infrahyoid flap. The tumor characteristics, location and size of the defect, resective and reconstructive techniques employed and the complications and outcomes of the speech and swallowing functions, as identified in the follow‑up visits every 3 months, were evaluated. All flaps were performed simultaneously in association with tumoral excision and ipsilateral supraomohyoid neck dissection. The mean size of the skin paddle was 7.0x3.5 cm. The donor site was primarily sutured. The postoperative course was uneventful and all flaps were viable. One case of marginal skin paddle loss occurred without affecting the survival of the flap. Five patients received postoperative radiotherapy and one patient received concurrent postoperative chemotherapy. During the follow‑up period (mean, 63 months), all patients showed excellent oral swallowing. Speech was excellent in five patients and in one patient speech was classified as good. The aesthetic results of the cervical donor site were good. Based on the present case report and the literature review, the infrahyoid flap is a simple and safe procedure for the reconstruction of the oropharynx, with a high success rate, minimal donor site morbidity and good aesthetic and functional results. The infrahyoid flap is a valid surgical option that may be considered in selected oncological patients undergoing reconstruction of medium-size oropharyngeal defects.

View Figures

View References

1	Cohan DM, Popat S, Kaplan SE, Rigual N, Loree T and Hicks WL Jr: Oropharyngeal cancer: Current understanding and management. Curr Opin Otolaryngol Head Neck Surg. 17:88–94. 2009. View Article : Google Scholar : PubMed/NCBI
2	Moncrieff M, Sandilla J, Clark J, Clifford A, Shannon K, Gao K and O'Brien C: Outcome of primary surgical treatment of T1 and T2 carcinomas of the oropharynx. Laryngoscope. 119:307–311. 2009. View Article : Google Scholar : PubMed/NCBI
3	Quon H, Yom SS, Garg MK, Lawson J, McDonald MW, Ridge JA, Saba N, Salama J, Smith R, Yeung AR and Beitler JJ: ACR Appropriateness Criteria: Local-regional therapy for resectable oropharyngeal squamous cell carcinomas. Curr Probl Cancer. 34:175–192. 2010. View Article : Google Scholar : PubMed/NCBI
4	Kelly K, Johnson-Obaseki S, Lumingu J and Corsten M: Oncologic, functional and surgical outcomes of primary transoral robotic surgery for early squamous cell cancer of the oropharynx: A systematic review. Oral Oncol. 50:696–703. 2014. View Article : Google Scholar : PubMed/NCBI
5	Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, Glisson B, Trotti A, Ridge JA, Chao C, et al: Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 349:2091–2098. 2003. View Article : Google Scholar : PubMed/NCBI
6	Garden AS, Harris J, Trotti A, Jones CU, Carrascosa L, Cheng JD, Spencer SS, Forastiere A, Weber RS and Ang KK: Long-term results of concomitant boost radiation plus concurrent cisplatin for advanced head and neck carcinomas: A phase II trial of the radiation therapy oncology group (RTOG99-14). Int J Radiat Oncol Biol Phys. 71:1351–1355. 2008. View Article : Google Scholar : PubMed/NCBI
7	Greven KM, White DR, Browne JD, Williams DW III, McGuirt WF Sr and D'Agostino RB Jr: Swallowing dysfunction is a common sequel after chemoradiation for oropharynx carcinoma. Am J Clin Oncol. 31:209–212. 2008. View Article : Google Scholar : PubMed/NCBI
8	Welkoborsky HJ, Deichmüller C, Bauer L and Hinni ML: Reconstruction of large pharyngeal defects with microvascular free flaps and myocutaneous pedicled flaps. Curr Opin Otolaryngol Head Neck Surg. 21:318–327. 2013.PubMed/NCBI
9	Seikaly H, Rieger J, Wolfaardt J, Moysa G, Harris J and Jha N: Functional outcomes after primary oropharyngeal cancer resection and reconstruction with the radial forearm free flap. Laryngoscope. 113:897–904. 2003. View Article : Google Scholar : PubMed/NCBI
10	Walvekar RR, Li RJ, Gooding WE, Gibson MK, Heron D, Johnson JT and Ferris RL: Role of surgery in limited (T1-2, N0-1) cancers of the oropharynx. Laryngoscope. 118:2129–2134. 2008. View Article : Google Scholar : PubMed/NCBI
11	Sabri A: Oropharyngeal reconstruction: Current state of the art. Curr Opin Otolaryngol Head Neck Surg. 11:251–254. 2003. View Article : Google Scholar : PubMed/NCBI
12	Torres-Carranza E, Infante-Cossío P, Hernández-Guisado JM, Hens-Aumente E and Gutierrez-Pérez JL: Assessment of quality of life in oral cancer. Med Oral Patol Oral Cir Bucal. 13:E735–E741. 2008.PubMed/NCBI
13	Infante-Cossio P, Torres-Carranza E, Cayuela A, Hens-Aumente E, Pastor-Gaitan P and Gutierrez-Perez JL: Impact of treatment on quality of life for oral and oropharyngeal carcinoma. Int J Oral Maxillofac Surg. 38:1052–1058. 2009. View Article : Google Scholar : PubMed/NCBI
14	Hurvitz KA, Kobayashi M and Evans GR: Current options in head and neck reconstruction. Plast Reconstr Surg. 118:122e–133e. 2006. View Article : Google Scholar : PubMed/NCBI
15	Wang HS, Shen JW, Ma DB, Wang JD and Tian AL: The infrahyoid myocutaneous flap for reconstruction after resection of head and neck cancer. Cancer. 57:663–668. 1986. View Article : Google Scholar : PubMed/NCBI
16	Rojanin S, Suphaphongs N and Ballantyne AJ: The infrahyoid musculocutaneous flap in head and neck reconstruction. Am J Surg. 162:400–403. 1991. View Article : Google Scholar : PubMed/NCBI
17	Magrin J, Kowalski LP, Santo GE, Waksmann G and DiPaula RA: Infrahyoid myocutaneous flap in head and neck reconstruction. Head Neck. 15:522–525. 1993. View Article : Google Scholar : PubMed/NCBI
18	Remmert SM, Sommer KD, Majocco AM and Weerda HG: The neurovascular infrahyoid flap: A new method for tongue reconstruction. Plast Reconstr Surg. 99:613–618. 1997. View Article : Google Scholar : PubMed/NCBI
19	Hell B, Heissler E, Gath H, Menneking H and Langford A: The infrahyoid flap: A technique for defect closure in the floor of the mouth, the tongue, the buccal mucosa, and the lateral pharyngeal wall. Int J Oral Maxillofac Surg. 26:35–41. 1997. View Article : Google Scholar : PubMed/NCBI
20	Lockhart R, Menard P, Chout P, Favre-Dauvergne E, Berard P and Bertrand JC: Infrahyoid myocutaneous flap in reconstructive maxillofacial cancer and trauma surgery. Int J Oral Maxillofac Surg. 27:40–44. 1998. View Article : Google Scholar : PubMed/NCBI
21	Zhao YF, Zhang WF and Zhao JH: Reconstruction of intraoral defects after cancer surgery using cervical pedicle flaps. J Oral Maxillofac Surg. 59:1142–1146. 2001. View Article : Google Scholar : PubMed/NCBI
22	Dolivet G, Gangloff P, Sarini J, Van Ton J, Garron X, Guillemin F and Lefebvre JL: Modification of the infra hyoid musculo-cutaneous flap. Eur J Surg Oncol. 31:294–298. 2005. View Article : Google Scholar : PubMed/NCBI
23	Gangloff P, Deganello A, Lacave ML, Verhaeghe JL, Lapeyre M, Maire F, Phulpin B, Guillemin F and Dolivet G: Use of the infra hyoid musculo-cutaneous flap in soft palate reconstruction. Eur J Surg Oncol. 32:1165–1169. 2006. View Article : Google Scholar : PubMed/NCBI
24	Tincani AJ, Del Negro A, Araújo PP, Akashi HK, Neves Fda S and Martins AS: Head and neck reconstruction using infrahyoid myocutaneous flaps. Sao Paulo Med J. 124:271–274. 2006. View Article : Google Scholar : PubMed/NCBI
25	Deganello A, Manciocco V, Dolivet G, Leemans CR and Spriano G: Infrahyoid fascio-myocutaneous flap as an alternative to free radial forearm flap in head and neck reconstruction. Head Neck. 29:285–291. 2007. View Article : Google Scholar : PubMed/NCBI
26	Seidl RO, Niedeggen A, Todt I, Westhofen M and Ernst A: Infrahyoid muscle flap for pharyngeal fistulae after cervical spine surgery: A novel approach-report of six cases. Eur Spine J. 16:501–505. 2007. View Article : Google Scholar : PubMed/NCBI
27	Minni A, Mascelli A and Suriano M: The infrahyoid myocutaneous flap in intra-oral reconstruction as an alternative to free flaps. Acta Otolaryngol. 130:733–738. 2010. View Article : Google Scholar : PubMed/NCBI
28	Mirghani H, Meyer G, Hans S, Dolivet G, Périé S, Brasnu D and Guily JL: The musculocutaneous infrahyoid flap: Surgical key points. Eur Arch Otorhinolaryngol. 269:1213–1217. 2011. View Article : Google Scholar : PubMed/NCBI
29	Deganello A, Gitti G, Parrinello G, Larotonda G, Meccariello G, Leemans CR and Gallo O: Infrahyoid flap reconstruction of oral cavity and oropharyngeal defects in elderly patients with severe general comorbidities. Head Neck. 34:1299–1305. 2012. View Article : Google Scholar : PubMed/NCBI
30	Ouyang D, Su X, Chen WC, Chen YF, Men QQ and Yang AK: Anatomical study and modified incision of the infrahyoid myocutaneous flap. Eur Arch Otorhinolaryngol. 270:675–680. 2013. View Article : Google Scholar : PubMed/NCBI
31	Peng H, Wang SJ, Yang X, Guo H and Liu M: Infrahyoid myocutaneous flap for medium-sized head and neck defects: Surgical outcome and technique modification. Otolaryngol Head Neck Surg. 148:47–53. 2013. View Article : Google Scholar : PubMed/NCBI
32	Perrenot C, Phulpin B, Mastronicola R, Gangloff P and Dolivet G: Infrahyoid myocutaneous flap for reconstruction after robotic transoral surgery for oropharyngeal tumors. Plast Reconstr Surg. 133:236e–237e. 2014. View Article : Google Scholar : PubMed/NCBI
33	Deganello A and Leemans CR: The infrahyoid flap: A comprehensive review of an often overlooked reconstructive method. Oral Oncol. 50:704–710. 2014. View Article : Google Scholar : PubMed/NCBI
34	Sobin LH, Gospodarowicz MK and Wittekind CH: Head and neck tumours. TNM Classification of Malignant Tumors (7th). Wiley-Blackwell. (Oxford). 22–62. 2009.
35	Robbins KT, Shaha AR, Medina JE, Califano JA, Wolf GT, Ferlito A, Som PM and Day TA: Committee for Neck Dissection Classification, American Head and Neck Society: Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg. 134:536–538. 2008. View Article : Google Scholar : PubMed/NCBI
36	World Medical Association Declaration of Helsinki: Recommendations guiding physicians in biomedical research involving human subjects. http://www.wma.net/en/30publications/10policies/b3/Accessed. August 04–2006
37	de Bree R, Rinaldo A, Genden EM, Suárez C, Rodrigo JP, Fagan JJ, Kowalski LP, Ferlito A and Leemans CR: Modern reconstruction techniques for oral and pharyngeal defects after tumor resection. Eur Arch Otorhinolaryngol. 265:1–9. 2008. View Article : Google Scholar : PubMed/NCBI
38	Koh KS, Eom JS, Kirk I, Kim SY and Nam S: Pectoralis major musculocutaneous flap in oropharyngeal reconstruction: Revisited. Plast Reconstr Surg. 118:1145–1149; discussion 1150. 2006. View Article : Google Scholar : PubMed/NCBI
39	Ricard AS, Laurentjoye M, Siberchicot F and Majoufre-Lefebvre C: The horizontal infrahyoid musculocutaneous flap in head and neck reconstruction. Br J Oral Maxillofac Surg. 47:76–77. 2009. View Article : Google Scholar : PubMed/NCBI
40	Deganello A, Gitti G, Parrinello G, Muratori E, Larotonda G and Gallo O: Cost analysis in oral cavity and oropharyngeal reconstructions with microvascular and pedicled flaps. Acta Otorhinolaryngol Ital. 33:380–387. 2013.PubMed/NCBI