Oropharyngeal Cancer & Pharyngeal Reconstruction

Chapter 20 of Volume 2, Head, Neck & Craniofacial. Revision notes and examiner-style viva questions with model answers for the FRCS (Plast).

28 viva questions in this chapter

1. You are shown a laryngectomy defect with the distal pharynx marked. How would you reconstruct this?
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2. Before you choose tissue — how do you classify this defect?
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3. Which flap, and why?
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4. How do you design the tube?
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5. Talk me through the inset.
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6. And if this were a patch defect rather than a tube?
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7. He has a BMI of 16. Does that change anything?
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8. What is refeeding syndrome, and how would you prevent it in him?
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9. He is also frail. How do you assess that, and does it change your decision?
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10. So what would you actually do before taking him to theatre?
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11. Which onlay flap?
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12. How would you manage him after the operation?
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13. What do you write before you leave theatre?
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14. Does he go to intensive care?
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15. What are your haemodynamic targets — and would you use a vasopressor?
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16. Antibiotics and thromboprophylaxis?
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17. How do you monitor a buried pharyngeal tube?
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18. Days one to three — what are you doing?
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19. What complications would you look for, and when?
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20. He is unwell on day six with a turbid drain. What is going on and what do you do?
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21. Six months later he cannot swallow solids. What now?
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22. The drain turns milky on day three. What is it and how do you manage it?
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23. A year later he has a paratracheal fistula, a heavily irradiated neck, and no obvious recipient vessels.
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24. How will this man speak?
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25. What are the long-term consequences of being a laryngectomee?
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26. When can he eat, and when does he go home?
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27. What are your discharge criteria?
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28. How would you review him on the ward round?
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