Surgical anatomy of soft palate carcinoma. Review
Abstract Introduction and objective: To describe clinical and anatomical features, and surgical treatment including several techniques of reconstructive surgery of soft palate carci-nomas. Method: We conducted a narrative review about soft palate carcinomas. We made a review on soft palate tumours pointing out anatomical details and most em-ployed reconstructive surgical techniques for soft palate carcinoma´s removal. Con-clusions: The incidence of oropharyngeal carcinoma is increasing world-wide esen-tially due to increasing prevalence of human papillomavirus. Initially, soft palate tu-mours are silent and we should suspect them to avoid late diagnosis. Transoral sur-gery development has promoted surgical treatment in these tumours and allows better management and need for adjuvant therapy. Reconstruction is mandatory when re-section is over 50% of the soft palate.
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1. Iyer NG, Nixon IJ, Palmer F, Kim L, Whitcher M, Katabi N, et al. Surgical management of squamous cell carcinoma of the soft palate: Factors predictive of outcome. Head Neck. 2012;34(8):1071–80. Disponible en: http://doi.wiley.com/10.1002/hed.21878 [Citado el 23/03/2020]
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3. Chen AY, Zhu J, Fedewa S. Temporal Trends in Oropharyngeal Cancer Treatment and Survival: 1998 – 2009. Laryngoscope. 2014;124:131–8.
4. Ángel J, García G, Pollán C, Virós D, Miguel C, Estomba C, et al. Reconstrucción de defectos orofaríngeos tras cirugía transoral robótica . Revisión y recomendaciones de la Comisión de Cirugía de Cabeza y Cuello de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Acta Otorrinolaringol Esp 2019;70(4):235-44. Disponible en: https://doi.org/10.1016/j.otoeng.2019.03.004 [Citado el 17/04/2020]
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6. Cho JH, Kim JK, Lee H, Yoon J. Surgical Anatomy of Human Soft Palate. J Larygology Otol. 2013;123:2900–4.
7. Rodrigo JP, Heideman DAM, García-Pedrero JM, Fresno MF, Brakenhoff RH, Díaz Molina JP, et al. Time trends in the prevalence of HPV in oropharyngeal squamous cell carcinomas in northern Spain (1990-2009). Int J Cancer. 2014;134(2):487–92.
8. Basterra Alegría J. Carcinomas de la faringe. Ponencia oficial del LVIII Congreso Nacional de la Sociedad de Otorrinolaringología y Patología Cervicofacial. Badalona: EUROMEDICE Ediciones Médicas;2007.
9. López F, Llorente JL, Álvarez-Marcos C, Morato M, Suárez C, Rodrigo JP. Resultados del tratamiento de los carcinomas epidermoides orofaríngeos mediante cirugía transoral. Acta Otorrinolaringol Esp. 2015;66(2):74–82.
10. Mehanna H, Evans M, Beasley M, Chatterjee S, Dilkes M, Homer J, et al. Oropharyngeal cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S90–96. Disponible en: http://www.journals.cambridge.org/abstract_S0022215116000529 [Citado el 17/04/2020]
11. Lewis-Jones H, Colley S, Gibson D. Imaging in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S28–31. Disponible en: http://www.journals.cambridge.org/abstract_S002221511600061X [Citado el 18/04/2020]
12. Osborne RF, Brown JJ. Carcinoma of the oral pharynx: an analysis of subsite treatment heterogeneity. Surg Oncol Clin N Am. 2004;13(1):71–80. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S1055320703001170 [Citado el 24/04/2020]
13. Beitler JJ, Quon H, Jones CU, Salama JK, Busse PM, Cooper JS, et al. ACR Appropriateness Criteria ® Locoregional therapy for resectable oropharyngeal squamous cell carcinomas. Head Neck. 2016;38(9):1299–309. Disponible en: http://doi.wiley.com/10.1002/hed.24447 [Citado el 31/03/2020]
14. Shah S, Goldenberg D. Robotic surgery for oropharyngeal cancer. Rambam Maimonides Med J. 2014;5(2):e0014.
15. Genden EM, Kotz T, Tong CCL, Smith C, Sikora AG, Teng MS, et al. Transoral Robotic Resection and Reconstruction for Head and Neck Cancer. Laryngoscope. 2011;121:1668–74.
16. Adelstein DJ, Ridge JA, Brizel DM, Holsinger FC, Haughey BH, O’Sullivan B, et al. Transoral resection of pharyngeal cancer: Summary of a National Cancer Institute Head and Neck Cancer Steering Committee Clinical Trials Planning Meeting, November 6-7, 2011, Arlington, Virginia. Head Neck. 2012;34(12):1681–703. Disponible en: http://doi.wiley.com/10.1002/hed.23136 [Citado el 31/03/2020]
17. Chapman CH, Yom SS. Oropharyngeal Cancer: a case for single modality treatment with transoral laser microsurgery. Arch Otolaryngol Head Neck Surg. 2009;135(12):1225–30. Disponible en: http://link.springer.com/10.1007/978-3-319-62642-0_7 [Citado el 31/03/2020]
18. Fernández-Fernández MM, Montes-Jovellar L, Parente Arias PL, Ortega Del Alamo P. TransOral endoscopic UltraSonic Surgery (TOUSS): a preliminary report of a novel robotless alternative to TORS. Eur Arch Otorhinolaryngol. 2015;272(12):3785-91 Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/25510983 [Citado el 23/04/2020]
19. De Almeida JR, Genden EM. Robotic surgery for oropharynx cancer: Promise, challenges, and future directions. Curr Oncol Rep. 2012;14(2):148–57.
20. Fossum CC, Chintakuntlawar A V, Price L, Garcia JJ. Characterization of the Oropharynx: Anatomy, Histology, Immunology, Squamous Cell Carcinoma & Surgical Resection. Histopathology. 2016;70(7):1021–9.
21. Espinosa Restrepo F, Martínez Capoccioni G, Martín Martín C. T1-T2 squamous cell carcinoma of the uvula: A little big enemy. Otolaryngol - Head Neck Surg. 2012;146(1):81–7.
22. Seikaly H, Rieger J, Zalmanowitz J, Tang JL, Alkahtani K, Ansari K, et al. Functional soft palate reconstruction: a comprehensive surgical approach. Head Neck. 2008;30(12):1615–23.
23. Bianchi B, Ferri A, Ferrari S, Copelli C. Myomucosal cheek flaps: applications in intraoral reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(3):353–9. Disponible en: http://dx.doi.org/10.1016/j.tripleo.2009.04.021 [Citado el 13/05/2020]
24. Moubayed SP, Osorio M, Buchbinder D, Lazarus C, Urken ML. Soft palate reconstruction using a combination of a turn-in flap and a radial forearm flap. Laryngoscope. 2017 Aug;127(8):1772–4. Disponible en: http://doi.wiley.com/10.1002/lary.26462 10.1002/hed.20919
25. Karle WE, Anand SM, Clain JB, Scherl S, Urken ML. Total Soft Palate Reconstruction Using the Palatal Island and Lateral Pharyngeal Wall Flaps. Laryngoscope. 2017;127(8):1772-74.
26. National Comprehensive Cancer Network. NCCN Guidelines Version 3.2019. Head and Neck Cancers. 2019.
2. Douglas WG, Rigual NR, Giese W, Bauer J, Wiseman SM, Loree TR, et al. Advanced soft palate cancer: The clinical importance of the parapharyngeal space. Otolaryngol - Head Neck Surg. 2005;133(1):66–9.
3. Chen AY, Zhu J, Fedewa S. Temporal Trends in Oropharyngeal Cancer Treatment and Survival: 1998 – 2009. Laryngoscope. 2014;124:131–8.
4. Ángel J, García G, Pollán C, Virós D, Miguel C, Estomba C, et al. Reconstrucción de defectos orofaríngeos tras cirugía transoral robótica . Revisión y recomendaciones de la Comisión de Cirugía de Cabeza y Cuello de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Acta Otorrinolaringol Esp 2019;70(4):235-44. Disponible en: https://doi.org/10.1016/j.otoeng.2019.03.004 [Citado el 17/04/2020]
5. Rouvière H, Delmas A. Anatomía humana descriptiva, topográfica y funcional. 10ª Ed. Masson;
6. Cho JH, Kim JK, Lee H, Yoon J. Surgical Anatomy of Human Soft Palate. J Larygology Otol. 2013;123:2900–4.
7. Rodrigo JP, Heideman DAM, García-Pedrero JM, Fresno MF, Brakenhoff RH, Díaz Molina JP, et al. Time trends in the prevalence of HPV in oropharyngeal squamous cell carcinomas in northern Spain (1990-2009). Int J Cancer. 2014;134(2):487–92.
8. Basterra Alegría J. Carcinomas de la faringe. Ponencia oficial del LVIII Congreso Nacional de la Sociedad de Otorrinolaringología y Patología Cervicofacial. Badalona: EUROMEDICE Ediciones Médicas;2007.
9. López F, Llorente JL, Álvarez-Marcos C, Morato M, Suárez C, Rodrigo JP. Resultados del tratamiento de los carcinomas epidermoides orofaríngeos mediante cirugía transoral. Acta Otorrinolaringol Esp. 2015;66(2):74–82.
10. Mehanna H, Evans M, Beasley M, Chatterjee S, Dilkes M, Homer J, et al. Oropharyngeal cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S90–96. Disponible en: http://www.journals.cambridge.org/abstract_S0022215116000529 [Citado el 17/04/2020]
11. Lewis-Jones H, Colley S, Gibson D. Imaging in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S28–31. Disponible en: http://www.journals.cambridge.org/abstract_S002221511600061X [Citado el 18/04/2020]
12. Osborne RF, Brown JJ. Carcinoma of the oral pharynx: an analysis of subsite treatment heterogeneity. Surg Oncol Clin N Am. 2004;13(1):71–80. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S1055320703001170 [Citado el 24/04/2020]
13. Beitler JJ, Quon H, Jones CU, Salama JK, Busse PM, Cooper JS, et al. ACR Appropriateness Criteria ® Locoregional therapy for resectable oropharyngeal squamous cell carcinomas. Head Neck. 2016;38(9):1299–309. Disponible en: http://doi.wiley.com/10.1002/hed.24447 [Citado el 31/03/2020]
14. Shah S, Goldenberg D. Robotic surgery for oropharyngeal cancer. Rambam Maimonides Med J. 2014;5(2):e0014.
15. Genden EM, Kotz T, Tong CCL, Smith C, Sikora AG, Teng MS, et al. Transoral Robotic Resection and Reconstruction for Head and Neck Cancer. Laryngoscope. 2011;121:1668–74.
16. Adelstein DJ, Ridge JA, Brizel DM, Holsinger FC, Haughey BH, O’Sullivan B, et al. Transoral resection of pharyngeal cancer: Summary of a National Cancer Institute Head and Neck Cancer Steering Committee Clinical Trials Planning Meeting, November 6-7, 2011, Arlington, Virginia. Head Neck. 2012;34(12):1681–703. Disponible en: http://doi.wiley.com/10.1002/hed.23136 [Citado el 31/03/2020]
17. Chapman CH, Yom SS. Oropharyngeal Cancer: a case for single modality treatment with transoral laser microsurgery. Arch Otolaryngol Head Neck Surg. 2009;135(12):1225–30. Disponible en: http://link.springer.com/10.1007/978-3-319-62642-0_7 [Citado el 31/03/2020]
18. Fernández-Fernández MM, Montes-Jovellar L, Parente Arias PL, Ortega Del Alamo P. TransOral endoscopic UltraSonic Surgery (TOUSS): a preliminary report of a novel robotless alternative to TORS. Eur Arch Otorhinolaryngol. 2015;272(12):3785-91 Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/25510983 [Citado el 23/04/2020]
19. De Almeida JR, Genden EM. Robotic surgery for oropharynx cancer: Promise, challenges, and future directions. Curr Oncol Rep. 2012;14(2):148–57.
20. Fossum CC, Chintakuntlawar A V, Price L, Garcia JJ. Characterization of the Oropharynx: Anatomy, Histology, Immunology, Squamous Cell Carcinoma & Surgical Resection. Histopathology. 2016;70(7):1021–9.
21. Espinosa Restrepo F, Martínez Capoccioni G, Martín Martín C. T1-T2 squamous cell carcinoma of the uvula: A little big enemy. Otolaryngol - Head Neck Surg. 2012;146(1):81–7.
22. Seikaly H, Rieger J, Zalmanowitz J, Tang JL, Alkahtani K, Ansari K, et al. Functional soft palate reconstruction: a comprehensive surgical approach. Head Neck. 2008;30(12):1615–23.
23. Bianchi B, Ferri A, Ferrari S, Copelli C. Myomucosal cheek flaps: applications in intraoral reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(3):353–9. Disponible en: http://dx.doi.org/10.1016/j.tripleo.2009.04.021 [Citado el 13/05/2020]
24. Moubayed SP, Osorio M, Buchbinder D, Lazarus C, Urken ML. Soft palate reconstruction using a combination of a turn-in flap and a radial forearm flap. Laryngoscope. 2017 Aug;127(8):1772–4. Disponible en: http://doi.wiley.com/10.1002/lary.26462 10.1002/hed.20919
25. Karle WE, Anand SM, Clain JB, Scherl S, Urken ML. Total Soft Palate Reconstruction Using the Palatal Island and Lateral Pharyngeal Wall Flaps. Laryngoscope. 2017;127(8):1772-74.
26. National Comprehensive Cancer Network. NCCN Guidelines Version 3.2019. Head and Neck Cancers. 2019.
Zabaleta-López, M., Ramos-Casademont, L., Díaz De Cerio-Canduela, P., Ibáñez-Muñoz, C., Lacosta-Nicolás, J. L., & Carreras-Alcaraz, A. (2020). Surgical anatomy of soft palate carcinoma. Review. Revista ORL, 11(4), 427–437. https://doi.org/10.14201/orl.23103
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