(Ivanhoe Newswire) — A new technique for reconstructing the palate after
tonsil cancer surgery maintained patients' ability to speak clearly and eat most
foods, a new study shows.
"This is the area that triggers swallowing, that separates the mouth from the
nasal cavity. It affects speech and eating – typically, patients have difficulty
eating when they have this kind of tumor and undergo surgery. We can remove the
cancer, but there are major quality of life issues," study author Douglas
Chepeha, M.D., M.S.P.H., associate professor of otolaryngology head and neck
surgery and director of the microvascular program at the University of Michigan
Health System, was quoted as saying.
The number of tonsil cancers has increased in recent years due to HPV, or human
papillomavirus, the virus that is also linked to cervical cancer.
Tonsil cancer develops in the back of the throat, which means surgery could
include parts of the palate, the tongue and the jaw. Traditional reconstruction
efforts have meant taking a large, round piece of tissue to plug the hole left
when the tumor is removed. But this impairs the way the palate and tongue
function, and does not restore the complex components of the throat that allow a
person to speak and swallow.
With the new technique, surgeons first create a tube from the remaining palate
by attaching the palate to the back part of the throat, next to where the tumor
was removed. This tube separates the mouth from the nasal cavity and closes
during swallowing, allowing patients to eat and speak.
The surgeons then sew up the defect in the base of the tongue to separate the
tongue from the rest of the reconstruction. This ensures the tongue can move,
which improves swallowing and speech. The shape of the remaining defect is
irregular, so a template is designed for using transplanted tissue to fill in
any other holes left by the surgery.
The tissue used in the reconstruction is transplanted from the patient's own
body.
The study followed 25 patients with tonsil cancer for an average of five years
after surgery. Patients were grouped based on how much of their palate was
removed during surgery: less than half or more than half.
Both groups reported few problems with speech. Patients who had more than half
their palate removed were more limited in what they could eat and reported some
restrictions to eating in public. Emotional scores were high for both groups,
suggesting overall satisfaction with their lives.
"In particular, patients who have less than half their palate removed do very
well with this reconstruction,” said Chepeha. “We're trying to make sure the
remaining tongue and palate they have really work. Our goal is to get patients
eating in public and back to work."
SOURCE: Archives of Otolaryngology – Head & Neck Surgery, September 2009
