Excellent Outcomes with Palate Reconstruction Surgery

From Clinical Update, Spring 2006

The use of the temporalis muscle to fill defects in the palate left by tumor resection has produced excellent outcomes for patients undergoing head and neck reconstruction procedures at Wake Forest University Baptist Medical Center.

Having done 400 major head and neck reconstruction procedures over the past decade, J. Dale Browne, M.D., professor of otolaryngology, is one of the region’s leading experts in both the microvascular “free flap” replacement of resected bone and soft tissue and the temporalis myofascial flap for palate replacement.

Although he didn’t invent it, Browne has pioneered the use of the temporalis muscle to rebuild the palate following removal of palatal and maxillary sinus malignancies, and is one of the few surgeons in the country doing it routinely.

Surgeons who treat these problems commonly rely on a prosthetic device such as a modified denture that fills the defect created by the removal of the tumor. This approach presents multiple concerns.

The temporalis flap, done at the time of the initial surgery, can provide superior results. In a paper published in Archives of Otolaryngology Head and Neck Surgery, Browne cites results from 16 cases and reports: “Fifteen (94 percent) of 16 patients were able to resume their preoperative diets. No velopharyngeal insufficiency was encountered. All flaps survived, and none required repeated surgical intervention.” Browne has since performed over 60 of these procedures and continues to see positive results.

Along with Chris Sullivan, M.D., Browne is the surgical arm of the Multidisciplinary Head and Neck Tumor Clinic and is commonly the point of entry consultant at Wake Forest Baptist for head and neck cancer evaluation and management.

The ability to perform both the cancer resection and reconstruction of the defect is a major benefit for the patient. In addition to the temporalis muscle flap, common reconstructions performed by Browne involve the transfer of donor replacement tissue along with a feeding artery and vein. Such procedures commonly involve the use of the iliac crest, fibula, rectus abdominus muscle, and wrist/forearm skin.

Browne recalled one recent patient who had no symptoms but whose dentist noticed a bump in the roof of her mouth. Subsequent biopsy led to the diagnosis of a salivary adenocarcinoma, and she was referred to Browne. To resect the tumor, Browne had to remove about half of the patient’s hard palate, part of the soft palate, and some teeth.

Following removal of the tumor, the patient’s temporalis muscle was transferred into the mouth and used to reconstruct her hard and soft palate. Her muscle flap healed uneventfully and her new palate functions normally.

She remains free of cancer years later.

The patient, an elementary school assistant principal, is delighted with the result. “It’s been a miracle. It’s been great,” she said.

“That whole facility could not be better. They’re much more than a doctor-patient relationship. They are there to help you in any way they can. And, you know, when you’re sick and you’re a patient, that means everything to you.”