The reconstructive options for oropharyngeal defects in the transoral robotic surgery framework

- Trans Oral Robotic Surgery is a prominent treatment for oropharyngeal tumors.
- Some defects are large and complex enough to benefit soft-tissue coverage.
- The reconstruction of large defects is challenging.
- The paradigm for reconstruction has undergone changes over the last few decades.
- The flap choice should be tailored in order to obtain significant advantages.

Transoral robotic surgery (TORS) is a fascinating new technique that has been proved to be a safe and feasible for selected oropharyngeal cancers. Furthermore, TORS offers several advantages in the treatment of locoregionally advanced cancers. Nevertheless, the careful selection of patients is the keypoint for a successful application of this therapeutic modality. However, the reconstruction of large oropharyngeal defects is challenging due to the restoration of velopharyngeal competency and swallowing. Moreover, the absence of mandibular splitting increases the difficulties faced by reconstructive surgeons. The paradigm for oropharyngeal reconstruction has undergone changes reflecting the overall change in the trend of the treatment alternatives over the last few decades. The flap choice and harvesting should be tailored in order to obtain significant advantages both in terms of function and should be easy to inset. In this review, we analysed the strengths and weaknesses of the various flaps used in the TORS framework.