12 - Oral cavity, tongue, and mandibular reconstructions

Abstract

The forearm, anterolateral thigh, and fibular flaps are the three most valuable flaps for buccal, tongue, and mandibular reconstructions. A radial or ulnar forearm flap is a reliable and easy technique for buccal or tongue reconstruction but with a conspicuous scar in the forearm. The anterolateral thigh flap, a thin perforator flap or a bulky myocutaneous flap, is versatile for most buccal reconstructions. Other emerging flaps are the femoral profunda artery perforator flap and superficial circumflex iliac artery perforator flap. Cheng’s modified classification of tongue defects indicates the selection of donor flaps. For type I and IIa defects, a thin fasciocutaneous flap, either radial or ulnar forearm flap from the non-dominant hand, can achieve satisfactory functional and aesthetic results. Type IIb and III defects often require a thicker flap, such as the anterolateral thigh myocutaneous flap or femoral profunda artery perforator flap, to accomplish the volumetric augmentation for swallowing function. The classification of mandibular defects was modified into I, II, and III to choose the best reconstructive option for functional and cosmetic outcomes. The fibula osseous flap has evolved to the fibula osteocutaneous flap with a skin paddle, followed by osteomyocutaneous peroneal artery combined flap with additional soleus to provide one-layer, two-layer to three-layer reconstructions with solid bony support and adequate soft-tissue volume for plate coverage or dead space obliteration. There are eight configurations based on mandibular defect sites, donor fibula laterality, peroneal skin paddle transfer, and recipient vessel selection. The comparisons of variable approaches and related outcomes are discussed.