Abstract
The objective of this study was to evaluate whether the extent of tumor resection and free flap reconstruction influences functional outcome and complications in patients with solid malignancies of the cheek. Therefore, we retrospectively assessed recipient site complications and functional outcomes in 47 patients with solid malignancies of the cheek who underwent either partial (n = 30; 63.8%) or full-thickness (n = 17; 36.2%) cheek resection with free flap reconstruction. Complications occurred in 12 (70.6%) patients after full thickness resections with creation of through-and-through defects compared to 14 (70.6%) patients with partial defects (p = 0.138). Among those 26 patients (55.3%), major recipient site complications, like development of salivary fistula or free flap loss, were observed in 10 (21.3%) and 2 (4.3%) cases, respectively, while minor complications, like wound dehiscence and local infections, were found in 14 (29.8%) and 9 (19.1%) patients. Complications were noticed particularly after reconstruction of suborbital defects (69.2%; p = 0.268), of which occurrence of salivary fistulae was the most common (46.2%; p = 0.035). Similarly, functional outcomes including oral incompetence, ectropion, and trismus were not affected by the extent of resection (p = 0.766). However, oral incompetence was higher in patients with tumors originating from the oral cavity (p = 0.020) and after the performance of mandibulectomy (p = 0.003). Overall, there was no difference in functional outcome or recipient site morbidity between tumor resections resulting in full-thickness and partial defects.
Highlights
In addition to trauma and burns, resection of malignancy represents the main cause for cheek defects requiring reconstruction [1,2]
Squamous cell carcinomas (SCCs) originating from the oral mucosa or skin are the most common tumor entity of the cheek and surgical tumor resection represents the mainstay of therapy [5,6]
Multicenter chart review of patients with solid malignancies originating in the cheek who underwent tumor resection and free flap reconstruction between 2012 and 2017
Summary
In addition to trauma and burns, resection of malignancy represents the main cause for cheek defects requiring reconstruction [1,2]. Malignancies can arise from the oral mucosa or the skin with infiltration of the submucosa, loose connective tissue, and mimetic muscles of the cheek [3,4]. These malignancies can infiltrate or even arise from neighboring structures, like the nasal cavity or the parotid gland. Depending on tumor size and level of invasiveness, extended resections may end up in partial or even though-and-through defects, requiring more complex reconstructions with free flaps [4,7]. Recent publications regarding buccal SCCs further indicate that more extensive tumor resections are even associated with improved oncologic outcome [3,8]
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