Clinical evaluation of intraoral reconstruction with free jejunal grafts

Abstract

The objective of this study was to evaluate the suitability of free jejunal grafts for oral reconstruction. Twenty-nine free jejunal grafts have been used to reconstruct the oral mucosa after radical resection for cancer since November 1991. Postoperative oral function, including conversational intelligibility, Japanese speech intelligibility, eating ability, degree of xerostomia, and incidence of postoperative complications, was evaluated in 9 patients. Severity of post-radiation xerostomia after surgery was evaluated with the use of a 100 mm visual analogue scale (VAS). The average scores of conversational intelligibility and Japanese speech intelligibility tests were 9.9 points and 61.6%, respectively. Six patients could eat normal food, and 3 could eat soft food. By fixing the mesenteric side of the jejunum to the mandible, it was possible to restore the lingual sulcus, which facilitates the use of dentures. Xerostomia was significantly less in patients with jejunal grafts (VAS, 10 mm) than in those with other types of flaps (VAS, 45 mm). Five jejunal grafts were lost because of vascular complications. In 4 patients, an oro-cutaneous fistula developed, and closure was necessary. Two patients had mesenteric lymph node swelling 1 year postoperatively, but the excised specimen showed only non-specific inflammation. One patient had postoperative ileus as an abdominal complication and underwent surgical treatment.