CT AND MR APPEARANCE OF RECURRENT MALIGNANT HEAD AND NECK NEOPLASMS AFTER RESECTION AND FLAP RECONSTRUCTION

PURPOSE: To describe the appearance of recurrent malignant neoplasms i n patients who have undergone resection of primary head and neck tumor s with flap reconstruction. METHODS: Thirty-two examinations, 26 CT an d 6 MR scans, were retrospectively reviewed in 25 patients with docume nted recurrent malignant neoplasms. Confirmation of disease was by bio psy or disease progression. The flaps included 15 myocutaneous, 6 free composite, 2 jejunal free grafts, and 2 combined jejunal and myocutan eous flaps. RESULTS: The most common location of recurrence was in the primary tumor bed involving the undersurface or suture line of the re construction flaps, 14 of 32 scans; both nodal and flap recurrence was seen in 12 of 32 scans. CONCLUSIONS: When examining patients who may have recurrent disease after flap reconstruction, the radiologist shou ld be aware of the type of flap used and the expected appearance. Tumo r recurrence in this patient population is manifest either as a focal recurrent mass at or near the suture line of the reconstruction flap, or nodal disease, usually in the contralateral neck.