Comparison of Free Colon Flap versus Free Jejunum Flap in the Treatment of Xerostomia

Abstract

After radiation or multiple surgeries for oral cancers the patients may develop various degree of xerostomia. They have difficulty in swallowing and speech, also tend to develop inflammation of mucosa, dental caries and even trismus. When the xerostomia is mild, it can be treated with medication or just by frequent hydration with water. When the xerostomia is more severe surgical correction may be an option, namely using free jejunum or colon flap to provide lubrication. However, in the literature there was no comparison between free colon and free jejunum flap for surgical treatment of xerostomia. Our hospital receives a large number of oral cancers due to consumption of betel nuts which causes 3000 new cases of oral cancers per year in our country. Among our patients 34 had xerostomia treated with surgery. For patients who had no family history of colon cancer and colonoscopy showed no abnormal findings, a free colon flap was selected for reconstruction of xerostomia. When the family history was not clear and the patients were old with polyps during previous colonoscopy, free jejunum flap was used. Technically the free jejunum flap was harvested from the second portion of jejunum. For colon flap a segment was harvested from right colon. The postoperative results were compared regarding easiness of surgery, bacteria count of the flap, amount and quality of lubrication, comfort of the mouth (including flavor of secretion), requirement of secondary debulking procedures, complications of surgery, infection of lung during follow-ups, etc. The patients reported different responses to the spontaneous movement of jejunum flap inside the mouth. The bad smell of colon flap disappeared after 3 months. The results regarding subjective issue were obtained in the outpatient clinic with questionnaire using 5-point likert scale. The objective data such as requirement of secondary debulking procedures, complications of surgery, and infection of lung during follow-ups were analyzed. Conclusion: In terms of quality of lubrication, both groups showed similar results. So far there are no patients who develop cancer from the flaps in either group, but jejunum flap seems to be a safer consideration for patients with long life expectancy.