Intraoral Soft Tissue Defects Research Articles

Precise maxillofacial soft tissue reconstruction: A combination of cone beam computed tomography and 3dMD photogrammetry system

IntroductionThe reconstruction of both extra- and intra-oral soft tissue defects, particularly in restoring the morphology of the lip and the corners of the mouth, has posed a significant challenge for surgeons. Inappropriate methods often lead to maxillofacial deformity which then causes psychological and functional problems. This study aimed to address the challenge of reconstructing extensive and complex maxillofacial soft tissue defects, mainly focusing on the lip, the corners of the mouth, and the surrounding areas. Materials and methodsWe developed a reconstruction approach by combining the 3dMDface System (3dMD) with the cone beam computed tomography (CBCT). Firstly, with the extra-oral incision line, we evaluated the shape and the size of the extra-oral defect with 3dMD digitally. Then we used the corresponding maxillary and mandible tooth positions to record the intra-oral defect, which was then converted to digital images by combining 3dMD and CBCT. The islands of the anterolateral thigh perforator flap were then designed after the locations of the perforators were detected with Doppler ultrasonography. ResultsA clinical case diagnosed as dermatofibrosarcoma protuberans was presented to illustrate the approach. The patient's tumor resection and the size of multiple defects were measured and simulated via the virtual surgery system. A three-island perforator flap from the descending branch of the lateral femoral circumflex artery was designed accurately. Two weeks postoperatively, the flap was healed as anticipated and the patient was satisfied with the profile. ConclusionThe combination of the 3dMD and CBCT technologies improves the accuracy and fitness of extra- and intra-oral soft tissue reconstruction.

The reliability of submental flap for soft tissue reconstruction in patients with carcinoma of the oral cavity

BackgroundThe submental island flap (SIF) is a reliable option for reconstruction of the defects of the oral cavity following cancer resection. Advantages include reliable axial vascular pedicle, low donor site morbidity, good functional and cosmetic outcome, shorter operative time and lower cost compared to free flap reconstruction. Materials and methodsA total of 32 consecutive patients with carcinoma of the oral cavity were included in this study. All patients underwent resection and immediate reconstruction with SIF pedicled the submental vessels. Donor and recipient site morbidity, functional outcome, and locoregional recurrences are reported. ResultsThe study included 22 males (69%) and 10 females. The mean age was 54 years (range of 31–79 years). The most common primary tumor site was the tongue (15 patients, 47%), followed by the buccal mucosa, alveolar margin, floor of mouth, lower lip and hard palate. In 25 patients (78%) the flap survived completely. Complete flap loss occurred in one patient (3%). Six patients (19%) developed complications related to flap vascularity. 21 patients (66%) resumed normal diet, while 11 patients (34%) tolerated only soft diet. Over a median follow up was of 15 months (range of 3–62 months), 21 patients (66%) are alive and disease free, while 8 patients died, of whom 4 of locoreginal recurrences. ConclusionsSIF is reliable for reconstruction of the intraoral soft tissue defects following cancer resection. The functional and cosmetic outcomes are satisfactory and donor site morbidity is low. Careful patient selection is necessary for favorable outcome.

Assessment of Quality of Life in Head-and-Neck Oncologic Patients with Intraoral Soft-Tissue Defects Reconstructed with Buccinator Myomucosal Flap.

The aim of this study is to evaluate the functional outcomes and quality of life (QoL) in oncologic patients with intraoral defects reconstructed with the buccinator myomucosal flap. A retrospective study was performed involving 39 patients with intraoral soft-tissue defects, reconstructed with a buccinator myomucosal flap during a six-year period. Patients completed the European Organization for Research and Treatment of Cancer questionnaires, the standard questionnaire (QLQ-C30) and the head-and-neck specific module (QLQ-H&N35). Thirty-nine patients with a mean age of 61.23 ± 15.80 years were included in the study. Thirty-three patients were diagnosed with an oncological condition (84.61%). Six patients (15.38%) developed orosinusal communication and underwent extensive debridement. The median global-health-status score was 79.27 and emotional performance was the lowest scoring, with a mean score of 76.93. As for the symptom items, the most outstanding were dental problems (33.33), oral opening (31.62) and dry mouth (37.61), followed by sticky saliva (24.79), problems with social eating (21.15) and pain (19.87). The most significant symptoms were radiotherapy-related adverse effects such as pain, fatigue, dental problems and dry mouth. Patients reconstructed with the buccinator myomucosal flap develop a good quality of life for all types of activities, and a correct function and aesthetics. Postoperative radiotherapy is associated with a poorer quality of life, and can lead to impairment of several symptoms such as swallowing, oral opening and dry mouth.

Comparative Evaluation of Freshly Prepared Versus Freeze-Dried Human Amniotic Membrane in Intraoral Soft Tissue Defects

Aim: The aim of the study is to evaluate the efficacy in treatment outcome while using freshly prepared human amniotic membrane against freeze dried human amniotic membrane in intraoral soft tissue defects. Method: This prospective study included 20 patients having postsurgical soft tissue defect requiring primary wound coverage with human amniotic membrane. Patients were divided randomly into 2 groups. In group A, freshly prepared human amniotic membrane was placed, while in group B, freeze-dried human amniotic membrane was placed. Patients were evaluated on the basis of following parameters: postoperative pain, swelling, rate of epithelialization, and interincisal distance over a period of 6 months. Result: The results showed no significant difference in the mean of the pain between both the groups except on the first postoperative day. No significant difference in terms of reduction in swelling and increase in interincisal distance postoperatively was found at any point while using either fresh or freeze-dried human amniotic membrane. Significant difference was found in the mean rate of epithelialization between the groups on the 7th and the 21st postoperative days. Conclusion: Thus, we conclude that freshly prepared human amniotic membrane in comparison to the freeze-dried human amniotic membrane accelerates epithelialization and healing when used in the repair of postsurgical oral mucosal defects.

Utilization of a Chimeric Medial Femoral Condyle Free Flap for Mandibular Osteoradionecrosis.

Background:Primary options for oromandibular reconstruction with osteocutaneous free flaps are the vascularized fibula and iliac crest. Complications of mandible reconstruction are not uncommon and include osteomyelitis, malunion, and osteoradionecrosis (ORN) after radiation therapy. The medial femoral condyle (MFC) free flap is an established salvage option for carpal reconstruction in hand surgery, frequently used for scaphoid nonunion and avascular necrosis. We hypothesize that the MFC flap can be utilized to restore blood supply and reverse the negative effects of radiotherapy in patients who require mandibular reconstruction due to ORN.Methods:A retrospective chart review was conducted at Beaumont Health System, Royal Oak, for patients who underwent MFC free flap reconstruction for mandibular ORN between the years 2012 and 2018. Demographic data, operative details, complications, medical comorbidities, and patient outcomes were retrospectively gathered.Results:A total of four patients were isolated. Four patients developed ORN after resection of squamous cell carcinoma and adjuvant radiotherapy. No patients experienced donor site deficits. Revisions after MFC reconstruction were dependent on individual aesthetics and involvement of neighboring tissue. All four patients continue to be followed with no current issues to the osseous component of the MFC flap.Conclusion:Utilization of the MFC periosteal flap is a viable option in selected patients to salvage nonunion/resorption of mandible reconstruction and ORN of the mandible. Our experience found that the MFC is able to provide pain resolution and healing of intraoral soft tissue defects, and may halt the progression of ORN of the mandible.

Vascular iliac myofascial flap to repair compound defect of the jaw

The vascular iliac myofascial flap is a compound flap with the deep circumflex iliac artery (DCIA) as the vascular pedicle, carrying the iliac bone and parts of the internal oblique, external oblique and muscle-fascial tissue that cover the surface of the iliac crest and inside the iliac bone. The aim of this study was to advocate a feasible surgical strategy for maxillofacial surgeons through our review of clinical applications and to improve the quality of life of patients after the operation. In recent years, Stomatology Hospital of Wuhan University has performed dozens of vascularized iliac myofascial flaps, not only to repair jaw defects but also to complete the repair of intraoral soft tissue defects. 20 patients were followed up. These patients with jaw tumors who received a vascular iliac myofascial flap to repair compound defects of the jaw from 2018 to 2020. The Quality of Life Questionnaire-Head and Neck Cancer-37 (QLQ-H&N37) was used to evaluate their speech function (Z=-0.061, P>0.05) and postoperative aesthetics (Z=-2.824, P<0.05). All patients obtained good surgical results and satisfaction in terms of aesthetics and function. The successful reconstruction of these cases prove that the vascularized iliac composite flap with myofascial tissue is a reliable flap for the reconstruction of maxillofacial defects.

Using free radial forearm flap in the repair of different soft tissue defects in the head and neck region

Aim: Radial forearm flap (RFF) is a reliable flap that can be easily used to repair tissue defects in all parts of the body, especially in the areas such as the oral cavity, cheek mucosa and the tongue. It is used for the repair of soft tissue defects as a fasciocutaneous flap, and it is also used as osteo- fasciocutaneous flap, with the radius bone being split into the flap. In this study, we retrospectively examined the cases in which tissue defect repair was performed with free radial forearm flaps in our clinic between the years of 2008and 2018. The purpose of this study; is the determination of the results of the use of the radial forearm flap in the reconstruction of different soft tissue defects belonging to the head and neck region.Material and Methods: RFF repair was conducted in 24 patients who were included in our study. 15 of the patients were male and 9 were female. The mean age of the patients was 49. The cause of tissue defect was tumoral invasion in 17 patients, trauma (traffic accident, fall) in 6 patients and gunshot wound in 1 patient.Results: Total flap loss was observed in 1 patient and partial flap loss was seen in 1 patient. No post-operative infection, bleeding or similar complications were observed. Donor site problems were observed in 4 patients, while the donor area of 2 patients recovered after secondary treatment, while the donor area of the other 2 patients was repaired with additional partial thickness skin grafts.Conclusion: Radial forearm flap with free transfer is an option that has been used safely for many years in many regions, especially in intraoral soft tissue defects such as tongue, inner cheek, and the floor of the mouth. Although harvesting of this flap is slightly easier than other flaps, it is a procedure that requires meticulousness and patience similar to every area where microsurgery exists. Although sacrificing one of the main vessels of the upper limb with this flap is a serious disadvantage, the advantages it offers, especially in the intraoral defects, still keeps the radial forearm flap popular over the years.

Anatomical study and clinical application of medial sural artery perforator flap for oral cavity reconstruction

The present study aims to provide anatomical evidence for clinical application of the medial sural artery perforator (MSAP) flap. The current study investigated the vascular anatomy of the flap, evaluated the postoperative appearance and function of the donor and recipient sites, and investigate the clinical value in reconstruction of oral cavity. Six lower limbs of Chinese adult cadavers were microsurgically dissected. The locations and courses of the medial sural artery perforators were identified and recorded, which provided an anatomical basis for clinical application. Then, 16 clinical cases employing this flap were evaluated, ranging from 3×4cm to 6×8cm, and were employed for defects in the oral cavity region. Sixteen clinical cases with intraoral soft tissue defects, which included four clinical cases with inner cheek defects, were successfully followed up for 10–47 months (24 months on average). The donor site function, contour of recipient site and oral function recovery were evaluated as acceptable or better in cases with intraoral soft tissue defect, which were further verifying the value of clinical application of MSAP in repairing oral cavity defects. Moreover, two typical clinical cases were described in detail. To conclude, the MSAP flap is a favorable choice for small- to medium-size defects based on minor donor site morbidity, satisfactory oral function recovery, perforator stability and adaptation of the pedicle for anastomosis in the oral cavity region.

Contemporary Management of Mandibular Fracture Nonunion—A Retrospective Review and Treatment Algorithm

Nonunion is an uncommon complication after mandibular fractures. The purpose of this investigation was to compare outcomes of patients with mandibular fracture nonunion who were treated with a 1- versus 2-stage approach and propose a pragmatic treatment algorithm for surgical management based on preoperative characteristics. The authors conducted a retrospective study consisting of patients who presented to 2 level 1 trauma centers for the management of mandibular fracture nonunion over a 10-year period. The primary predictor variable was 1- versus 2-stage treatment. Outcomes were examined to propose a treatment algorithm. Eighteen patients were included in the study. The sample's mean age was 44.0±19.3years and most were men (88.9%). Mandibular angle and body accounted for 77.8% of cases. A single-stage approach was used in 13 patients (72.2%). Bone grafts or vascularized bone flaps were required in 13 patients (72.2%). Patients who required 2-stage treatments had intraoral soft tissue defects. Mean length of follow-up was 13.3±20.4months. All patients achieved bony union, with complications occurring in 5 patients (27.8%). The authors' 10-year experience was used to formulate a treatment algorithm based on bony defect size and soft tissue status, which can be used to inform optimal surgical management. Nonunion of mandibular fractures is an infrequent and complex condition requiring careful and deliberate surgical management. A single-stage approach is appropriate in most cases and does not negatively affect outcomes. Bony defect size and soft tissue status are essential parameters for determining the approach and timing of reconstruction.

New aspects in free flap surgery: Mini-perforator flaps and extracorporeal flap perfusion.

The scope of microvascular tissue transfer in the Head and Neck reaches from coverage of simple soft tissue defects to complex 3-D reconstructions using multiple or chimeric flaps. This paper summarises the presentation given at the Congress of the French Society of Oral and Maxillofacial Surgery in Marseille 2017. It was the aim of our work to add further elements to this wide spectrum of reconstructive possibilities. For patients with small intraoral soft tissue defects in whom the use of a radial forearm flap would not be justified because of its donor site morbidity, but who nevertheless would take a benefit from a small free flap, we used mini-perforator flaps from the lower leg. These flaps were raised with negligible morbidity. Moreover, for patients necessarily needing a free flap, but having vessel depleted, irradiated necks, we have developed a first idea of extracorporeal flap perfusion to make microvascular anastomoses unnecessary. Using donor sites from the lower leg, mini-soleus and medial sural perforator flaps were raised to cover defects of 2×3 to 2×4cm at the anterior floor of the mouth or lateral tongue. The success rate was 91%, and despite their small size, the flaps helped to maintain the mobility of the tongue. The donor site morbidity was minimal. After extensive experimental work on small animals and human tissue, four flaps could successfully be transferred so far by means of extracorporeal perfusion. In these patients, autonomisation took place between 5 and 12 days. Although microvascular tissue transfer already allows for reconstruction in almost any possible defect constellation, mini-perforator flaps and machine-perfused transplants seem to represent new aspects of free flap surgery, being useful extensions of the reconstructive surgeon's armament.

USE OF POSTERIORLY BASED TONGUE FLAP IN RECONSTRUCTION OF INTRAORAL MAXILLARY SOFT TISSUE DEFECTS FOLLOWING EXCISION OF MAXILLARY BENIGN SOFT TISSUE TUMORS

Aim of the study: The current study aimed to evaluate the efficacy of posterior-based tongue flap for reconstruction and restoring function and esthetics of intraoral posterior maxillary soft tissue defects following surgical excision of large maxillary benign soft tissue granulomas.Patients and methods: This study was carried out on 10 female patients aged from 37 to 55 years (men age: 46) who had been planned for treatment with posterior-based tongue flap procedure for reconstruction of intraoral maxillary soft tissue defects following surgical excision of large maxillary benign soft tissue tumors and/or granulomas. The first sessions were carried out under general anesthesia and aimed to surgical excision of the tumor and reconstruction the soft tissue defects with posterior-based tongue flap. In the second session, the pedicle was divided under local anesthesia. Between the first and second sessions, the period of time needed was 15 to 21 days. The proximal part of the pedicle was returned to the donor site in the second session. Postoperative clinical follow up and recall was scheduled at 1, 3, 6, 9, and 12 months postoperatively.Results: All the flaps survived but one flap had temporary venous congestion after flap division. No recurrence was noted. Good aesthetic and functional results were achieved. No post-operative wound dehiscence and wound infection were recorded. The soft tissue contour at the recipient sites was clinically satisfactory.Conclusion: Despite the disadvantages of being an interpolation flap which requires a second session and good patient cooperation, posterior-based tongue flap is a choice for reconstruction of intraoral posterior maxillary soft tissue defects following surgical excision of large maxillary benign soft tissue tumors or granulomas with its highly vascular structure, good mobility, localization, texture match, and low donor area morbidity.

Fibular flap for mandible reconstruction in osteoradionecrosis of the jaw: selection criteria of fibula flap.

BackgroundOsteoradionecrosis is the most dreadful complication after head and neck irradiation. Orocutaneous fistula makes patients difficult to eat food. Fibular free flap is the choice of the flap for mandibular reconstruction. Osteocutaneous flap can reconstruct both hard and soft tissues simultaneously. This study was to investigate the success rate and results of the free fibular flap for osteoradionecrosis of the mandible and which side of the flap should be harvested for better reconstruction.MethodsA total of eight consecutive patients who underwent fibula reconstruction due to jaw necrosis from March 2008 to December 2015 were included in this study. Patients were classified according to stages, primary sites, radiation dose, survival, and quality of life.ResultsFive male and three female patients underwent operation. The mean age of the patients was 60.1 years old. Two male patients died of recurred disease of oral squamous cell carcinoma. The mean dose of radiation was 70.5 Gy. All fibular free flaps were survived. Five patients could eat normal diet after operation; however, three patients could eat only soft diet due to loss of teeth. Five patients reported no change of speech after operation, two reported worse speech ability, and one patient reported improved speech after operation. The ipsilateral side of the fibular flap was used when intraoral soft tissue defect with proximal side of the vascular pedicle is required. The contralateral side of the fibular flap was used when extraoral skin defect with proximal side of the vascular pedicle is required.ConclusionsOsteonecrosis of the jaw is hard to treat because of poor healing process and lack of vascularity. Free fibular flap is the choice of the surgery for jaw bone reconstruction and soft tissue fistula repair. The design and selection of the right or left fibular is dependent on the available vascular pedicle and soft tissue defect sites.

The medial sural artery perforator flap in intra-oral reconstruction: A Northeast experience

The medial sural artery perforator (MSAP) flap is a fasciocutaneous flap that is gaining popularity for intra-oral reconstructions. The aim of this two-centre review was to evaluate the use of the MSAP flap in intra-oral reconstructions and report our experiences. Data were collected prospectively on 35 consecutive intra-oral reconstructions using the free MSAP flap. Patient details and intraoperative flap details were recorded. Thirty-five patients underwent intra-oral reconstruction with a free MSAP flap (26 males and nine females). The average flap dimensions were a length of 8.03cm, a width of 5.0cm and a thickness of 7.1mm. Twenty-two flaps had two perforators, and the average pedicle length was 11.1cm. There were no flap losses. Ninety-one per cent of donor sites were closed primarily. There were two minor complications related to donor-site wound dehiscence, which required delayed skin grafting. The overall complication rate was 5.7%. The MSAP flap is a good choice for intra-oral reconstruction. It has reliable anatomy and provides thin, pliable skin with a long pedicle. In addition, donor morbidity is low as the donor site can be closed directly in most cases. It is currently our flap of choice for small intra-oral soft tissue defects.

Mandibular Reconstruction With Iliac Crest Free Flap, Nasolabial Flap, and Osseointegrated Implants

Oncologic patients undergoing segmental mandibulectomy with soft tissue resection develop several esthetic and functional sequelae; therefore, the defect must be reconstructed immediately. The iliac crest flap is the only flap that allows reconstruction of the previous dimensions of the mandible. However, the excessive soft tissue of this flap prevents optimal reconstruction of intraoral soft tissue defects. This report describes a reconstructive technique used in 12 patients who underwent segmental mandibulectomy because of soft tissue defects resulting from tumor resection. The technique involves reconstruction of the mandible using an iliac crest flap combined with a nasolabial flap to enable subsequent reconstruction of the intraoral soft tissue and immediate placement of osseointegrated implants. The osseointegration success rate was 95.2% with a failure rate of 4.8%. Failure particularly affected the irradiated patients. Excellent functional and aesthetic results were obtained with the iliac crest free flap, nasolabial flap and osseointegrated dental implants. This technique has several advantages. On the one hand, it enables reconstruction of the original dimensions of the mandible, thus allowing immediate placement of implants in an ideal position for subsequent rehabilitation with a dental prosthesis. On the other hand, the nasolabial flap provides a thin layer of tissue that can be used to reconstruct the anatomy of the oromandibular soft tissue.

Submental flap in intraoral reconstruction after pathologic resections: indications and limitations.

Submental flap is used to reconstruct intraoral and facial soft tissue defects. Submental flap is used for intraoral reconstruction in eighteen patients. Complications of this flap that includes local recurrence, remaining metastatic lymph node in the field of neck dissection, wound dehiscence at donor site and probability of transferring metastatic tissue are evaluated. This flap is used as an alternative to free tissue transfer, and this article presents 18 cases after pathologic lesion resections, such as verrocous carcinoma (2 patients), odontogenic myxoma (1 patient), oral squamous cell carcinoma (SCC) (10 patients), adenoid cystic carcinoma (2 patients), leukoplakia (2 patients) as well as osteosarcoma in one patient. There was no case of local recurrence and remaining metastatic lymph node in the field of neck dissection. A case of metastatic lymph node involvement in posterior triangle of the neck, 2years after surgery was occurred. One case of metastatic tissue transfer and a case of wound dehiscence in submental region are reported. Submental flap is an useful aid for reconstruction of oral cavity mucosal defects. Its use in oral SCC reconstruction should be done in carefully selected cases.

Iliac crest inner table free flap vs free fibula flap for mandibular reconstruction

Introduction: The main objectives in mandibular reconstruction search to recover shape, function and aesthetics. To achieve these objectives free flaps are performed. Currently fibula and iliac crest free flap are the main options for mandibular reconstruction. Preoperative planning and rapid prototyping, let us achieve better results, obtaining a better tridimensional reconstruction. Nevertheless it does not exist a treatment protocol to use the best flap for mandibular reconstruction, depending on the type of mandibular defect, initial diagnosis, bone free flap qualities, need for further dental rehabilitation or the association of an intraoral or extraoral soft tissue defect.

The evolving role of free flaps and pedicled flaps in head and neck reconstruction

This article reviews literature pertaining to the evolution in head and neck reconstruction techniques over the past two decades, specifically the changing patterns of usage of locoregional flaps and microvascular free tissue transfer. Most literature demonstrates a continuing trend favoring microvascular free tissue transfer for the majority of large defects. A few pedicled flaps, some new and some resurrected, now provide expanded and sometimes superior options for certain head and neck defects. Considerations driving flap choice include defect composition, oncologic, aesthetic, and functional factors. Although osteocutaneous microvascular free flaps remain the standard of care for composite oromandibular defects, there may be a groundswell in the use of certain locoregional pedicled flaps for reconstructing many facial, intraoral and pharyngeal soft tissue defects. Evolution in the use of these locoregional flaps may help improve upon the standard of care for reconstructive options.

Reconstruction of Combined Oral Mucosa-Mandibular Defects Using the Vascularized Myoosseous Iliac Crest Free Flap

The authors present five cases of combined oral mucosa-mandible defects reconstructed with the vascularized internal oblique-iliac crest myoosseous free flap. This technique has many advantages compared to other conventional methods such as the radial flap, scapula flap, and fibula flap. Vascularized iliac crest flaps provide sufficient high-quality bone suitable for reconstructing segmental mandibular defects. Although fibular flaps allow longer donor bone tissue to be harvested, the iliac crest can provide an esthetic shape for mandibular body reconstruction and also provides sufficient bone height for dental implants. Conventional vascularized iliac crest myoosseous flaps have excessive soft tissue bulk for reconstruction of intraoral soft tissue defects. The modification discussed in the present article can reduce soft tissue volume, resulting in better functional reconstruction of the oral mucosa. Another advantage is that complete replacement of the oral mucosa is observed in as early as one month post-operation. The final mucosal texture is much better than that obtained with other skin paddle flaps, which is especially beneficial for the placement of dental implant prostheses. Donor site morbidity looks to be similar to, if not less than that observed for other modalities in terms of function and esthetics. For combined oral mucosa-mandible defects, the vascularized internal oblique-iliac crest myoosseous free flap shows good results with respect to hard and soft tissue reconstruction.

The submental flap for oral cavity reconstruction: Extended indications and technical refinements

Background and purposeThe submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. However, its role in composite defects involving the jaw is not clearly defined. Indeed, controversy exists about the flap's interference with an oncologically sound neck dissectionPatients and MethodsA total of 21 patients with oral cavity cancers over a three year period were included. All patients underwent surgical resection and immediate reconstruction with submental flap except one patient who had delayed reconstruction with reversed flap. The flap was used for reconstruction of intra-oral soft tissue defect in 13 patients and composite defects in 8 patients.ResultsOf 21 patients 12 were males and 9 were females, age ranged from 32 to 83 years. The primary tumor sites included buccal mucosa (7), tongue (4), alveolar margin (3), floor of mouth (5) and lip (2). Eventually in this study, we adopted completing the neck dissection first before flap harvest. Complete flap loss occurred in 2 whereas 3 patients had partial flap loss. Follow up ranged from 3 to 44 months, one patient died from metastatic disease. Four patients developed neck recurrences.ConclusionThe submental flap is a valid option for reconstruction of intra-oral soft tissue as well as composite oral defects particularly in elderly patients. However, oncologically sound neck dissection should be assured.

Deep circumflex iliac artery free flap in the mandibular reconstruction

Vascularized iliac crest flap include bone tissue of good quality and quantity for mandible segmental defect. Even if fibular flap can contain longer bone tissue, iliac crest has esthetic shape for mandible body reconstruction and large height for implant. Conventional vascularized iliac crest osteomyocutaneous flap is too bulky for reconstruction of intraoral soft tissue defect. But modified flap can reduce soft tissue volume, so is good for functional reconstruction of oral mucosa. It takes only one month for completely replace oral mucosa. The final mucosal texture is much better than other skin paddle flap, especially for implant prosthesis. Donor site morbidity of this method looks same level or less with other modalities functionally and socially. In case of oral mucosa-mandible combined defect, vascularized iliac crest with internal oblique muscle flap shows good outcomes for hard and soft tissue.