Author(s)
James M. Hamilton MD
David Cognetti MD
Howard Krein MD
Affiliation(s)
Thomas Jefferson University Hospital
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be aware of the option palatoplasty with a posterior pharyngeal flap as a possibility for successful, functional correction of velopharyngeal insufficiency following bilateral transoral robotic radical tonsillectomy. Objectives: We report the case of pharyngeal flap reconstruction for debilitating velopharyngeal insufficiency with hypernasal speech following staged TORS resection of simultaneous squamous cell carcinoma of bilateral palatine tonsils. Study Design: Case report and literature review. Methods: Retrospective review, photographic depiction, and video presentation of a case record at a tertiary care medical center. Literature review using a PubMed search for bilateral tonsillar carcinoma, dysphagia, and velopharyngeal insufficiency. Results: We present a 68 year old female with bilateral palatine squamous cell carcinoma. She presented with biopsy proven p16 positive disease in the right tonsil and initially underwent transoral robotic resection with buccal fat graft repair of palatal defect and right neck dissection. Biopsy of the contralateral left tonsil at this time revealed simultaneous squamous cell carcinoma. Three weeks later she underwent transoral robotic radical resection of left tonsil and left neck dissection. She was staged T1N1 on the right and T1N0 on the left. No adjuvant therapy was required. On followup, however, she complained of hypernasality so severe that it limited her social interaction. At three months post-resection, she underwent palatoplasty with posterior pharyngeal flap. At postoperative week one she was tolerating liquids without nasal regurgitation. At three months, she reported near normal voice and had returned to her normal routine. She is currently three years since treatment and remains without evidence of malignancy and without voicing or swallowing complaints. Conclusions: In the appropriately selected patient, treatment of simultaneous, bilateral squamous cell carcinoma of the palatine tonsils with staged TORS resections is a viable option despite the risk of velopharyngeal insufficiency, which can be corrected with palatoplasty utilizing a posterior pharyngeal flap.