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Reconstruction of a resected palate is possible and done in various instances.
Reconstruction of a resected palate is possible and done in various instances, such as:
- Post-surgical removal of cancer
- Correction of cleft palate
- Obstructive sleep apnea
Even with advanced medical techniques, palate reconstruction remains a challenging task.
What are the 2 types of palate?
The roof of the mouth is called the palate, which is of two types:
- Hard palate: This is the bony part of the palate made of four cranial bones.
- Two maxilla bones
- Two palatine bones
- Soft palate: The soft muscular part continues toward the back and forms the uvula.
Surgical resection for soft palate cancer
It is well-known that oropharyngeal cancer accounts for about 12 percent of all head and neck cancers, and squamous cell carcinoma (SCC) accounts for more than 90 percent of oropharyngeal malignancies.
Squamous cell carcinoma (SCC) is mostly seen in the peritonsillar region, followed by the tongue base, soft palate, and oropharyngeal wall. SCC of the soft palate and uvula is uncommon, but if detected early, most instances of soft palate cancer can be treated with surgical resection and treatment.
Another treatment option for advanced soft palate cancer is a combination of surgical excision and postoperative radiation.
Hard vs. soft palate resection and reconstruction
Hard palate
The hard palate refers to the bones at the roof of the mouth. The removal of part or all the bony components of the palate, which comprises the maxilla and palatal bone, is called hard palate resection.
Surgery may be used to remove hard palate cancer. The procedure is called maxillectomy, which is of two types:
- Total maxillectomy: All bones of the palate or mouth’s roof are removed.
- Partial maxillectomy: Most of them and some of the palate bones are removed.
Both forms of surgery create a hole in the roof of your mouth that extends into the nose. If the tumor is small, the surgical hole can be closed with adjacent tissue (reconstruction). The surgeon can create a free flap or fake portion (a prosthesis) to bridge the gap and seal between the nose and mouth, and eventually, the wound heals.
Soft palate
A soft palate resection is the surgical removal of a piece or the entire soft palate, which is the non-bony component of the palate right behind the hard palate. Reconstruction of a soft palate deficit is the most challenging task for the surgeon.
Depending on the size and location of the tumor, soft palate resection is performed via the following approaches:
- Transoral is an invasive open surgery to remove tumors
- Transoral robotic-assisted surgery (TORS) is a rarely used approach to removing the cancer of the soft palate, where the tumor is removed by a step-by-step surgical technique using TORS
A neck dissection could be done along with soft palate excision to remove cervical lymph nodes.
To treat language impairment and dysphagia caused by surgical removal of a soft palate, surgical reconstruction with a different prosthesis is to be performed. Although prosthesis reconstruction appears quite simple, the post-surgical rehabilitation and complications with speech make it complicated in terms of recovery and patient satisfaction.
Surgical removal and reconstruction of palate
Uvulopalatal flap
This is an invasive procedure that requires general anesthesia. An incision on the mucosal layer of the soft and hard palate is done. The uvula is rolled up toward the incision and sutured to the soft palate. This flap is manipulated to make a wider airway and improve breathing. This treats obstructive sleep apnea.
Buccal mucosal flap
A buccal flap procedure is performed inside the mouth. A small incision is made on the back of the soft palate to make some space between the hard palate in the front and the soft palate in the back.
A finger-like piece of the skin (“flap”) from the inside of the cheek (“buccal mucosa”) is pushed up and rotated around to fill the newly formed gap. To maintain its blood supply, the flap is linked to the cheek on one edge. Small stitches are used to seal the interior of the cheek, where the flap is removed.
Radial forearm free flap
A radial forearm free flap is one method of filling the defect created by cancer removal. It is one of the most prevalent methods of restoring tissue in the head and neck, particularly following the removal of oral malignancies. It may be used to replace vast sections of the mouth and has the benefit of not shrinking when it heals, thus speech and swallowing are unaffected.
A small flap from the forearm that includes skin, fat, and blood vessels is removed. This flap is transferred to the hole on the head and neck after the removal of cancer. The opening on the forearm is closed with a skin graft.
However, these flap surgeries may result in donor site problems and inadequate functional results.
Palatine prosthetics
Prosthetics can be used in the adynamic repair of soft palatal abnormalities.
- Prosthetics enable quick restoration of speech and swallowing following surgery, which eliminates the need for alternate enteral nourishment.
- The capacity to use a prosthetic is frequently influenced by the patient's teeth condition and the degree of surgical resection.
- Due to the few anchor sites for the prosthesis, individuals with no teeth are difficult to rehabilitate with a prosthetic alone.
9 risks that follow palate reconstruction surgery
The risks of palate reconstruction surgery include:
- Higher chances of bleeding following palate surgery
- Wound infection
- Pain and swelling
- Difficulty swallowing
- Issues with speech, which may be permanent rarely
- Dryness and sensation of a foreign object in the throat
- Narrowing of space behind the palate following surgery
- The instruments may damage the teeth
- Snoring may be continued for some time even if the surgery is done for obstructive sleep apnea, which resolves gradually with healing