Imaging of Recurrent Head and Neck Tumors in Patients with Prior Flap Reconstruction
The purpose of this study is to provide a comprehensive description of the spectrum of imaging characteristics and distribution of recurrent disease in patients with head and neck cancers reconstructed with flaps, which may allow salvage surgery and contribute to improved survival.
Computed Tomography images and clinical data of all consecutive patients who underwent head and neck tumor resection, neck dissection and flap reconstruction over 7.5 year period were reviewed. Imaging findings were correlated with flap type, recurrence site, and time to recurrence and clinical suspicion.
Recurrence occurred in 29 of the 82 patients, with average time to recurrence at 9 months. Recurrence was clinically suspected in 62% of patients by detecting a new neck mass. Almost 76% of recurrent tumors were solid enhancing masses and over 24% were necrotic masses. While most recurrent lesions occurred at the margin of free flap, 31% were found remotely from the flap. There was no statistical correlation between flap type, recurrence characteristics, recurrence site and either time to recurrence or clinical suspicion.
The majority of patients with recurrent disease following flap reconstruction developed their recurrence within the post-operative first eight months. Recurrent tumors typically present as infiltrating, enhancing masses which may have necrotic foci, and tend to occur along the flap margin and/or suture line. Approximately 38% of recurrences were not clinically suspected. Routine 3-month baseline imaging then further 3-month interval follow-up in the first year should be considered in patients with flap reconstruction for head and neck malignancy.