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Procedure can help reverse tonsil cancer surgery damage

U-M Health System photo

A technique for reconstructing the palate after surgery for tonsil cancer developed by Dr. Douglas Chepeha of the University of Michigan Health System maintained patients' ability to speak clearly and eat most foods, a new study shows.

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Published: October 6, 2009

Updated:

The traditional procedure surgeons have used to remove cancerous tonsils can often include the removal of patients' palates, tongues and jaws, which can destroy their ability to talk and swallow.

A procedure developed at the University of Michigan Comprehensive Cancer Center can help reduce this collateral damage, according to a study published in the September issues of the journal Archives of Otolaryngology – Head & Neck Surgery.

The traditional reconstruction following the removal of cancerous tonsils involves taking a large, round piece of tissue to plug the hole left behind. The repair, however, impairs the way the palate and tongue function, and does not restore the parts of the throat that allow a person to speak and swallow.

"This is the area that triggers swallowing, that separates the mouth from the nasal cavity," said Dr. Douglas Chepeha, associate professor of otolaryngology head and neck surgery. Chepeha, director of the microvascular program at the University of Michigan Health System, was the author of the U-M study.

With the traditional repair technique, "we can remove the cancer, but there are major quality of life issues," Chepeha said.

The U-M study followed 25 tonsil cancer patients who underwent the new reconstructive technique. They were divided into two groups, based on how much of their palate was removed during surgery: less than half or more than half.

Both groups reported few problems with speech, but the patients who lost more than half their palate were more limited in what they could eat and had some restrictions on eating in public places.

"We're trying to make sure the remaining tongue and palate they have really work," Chepeha said. "Our goal is to get patients eating in public and back to work."

From an emotional standpoint, patients in both groups appeared to be generally satisfied with their post-surgical lives.

In the Michigan procedure, surgeons create a tube from the palate tissue that remains following the removal of the malignant tonsils. They attach the palate to the back of the throat, next to where the tumor was removed. The tube separates the mouth from the nasal cavity and closes during swallowing, allowing patients to eat and speak.

The surgeons next sew up the defect created in the base of the tongue, separate the tongue from the rest of the reconstruction. This ensures that the tongue can move, which improves swallowing and speech.

The shape of the remaining defect is irregular, so a template resembling a dress pattern is created from transplanted skin tissue taken from the patient's arm or some other body area. The tissue fills in any other holes left by the surgery.

The number of tonsil cancer cases in the country is on the rise. Researchers believe the main culprit is the human papilloma virus. The sexually transmitted HPV has also been implicated in cancers of the vagina, uterus and anus.

During 2009, 12,610 Americans will be diagnosed with throat cancer and 2,230 will die from the disease, according to the National Cancer Institute. The tonsils are one of three locations in which throat cancer occurs.

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