Considerations for free-flap reconstruction of the hard palate

Objective: To evaluate the use of microvascular free-tissue transfers in the reconstruction of hard palate defects. Design: Retrospective review of a case series. Setting: Two tertiary referral centers. Patients: Thirty patients had hard palatal defects that resulted from ablative oncologic surgery: 10 total or subtotal palatal defects, 14 hemipalatal defects, and 6 anterior arch defects. Intervention: Nine fibular, II rectus abdominus, 3 scapular, 6 radial forearm, and 1 latissimus dorsi free flaps were used to reconstruct these defects. Main Outcome Measures: Separation of the oral cavity from the nasal and sinus cavities, complications, oral diet, speech intelligibility, and overall quality of life. Results: No flap failures occurred, and all palatal defects were ultimately sealed. Nineteen patients eat a regular diet, while the remainder maintain a soft diet. Twelve patients use a conventional dental prosthesis: 8 of the dental prostheses are supported by implants. Of 23 patients examined for speech, 18 have no disorders, 3 exhibit hyponasal speech, and 2 have hypernasal speech. Overall University of Washington, Seattle, quality of life scores were fair in 2 patients, good in 6, and excellent in 12. Conclusions: Free-flap reconstruction of the palate provides reliable permanent separation of the oral and sinonasal cavities in one stage. In addition, the potential for dental rehabilitation with the restoration of masticatory function and normal phonation exists. Flap choice is tailored to specific palatal defects as well as patient needs.