Reconstruction Of Oral Cavity Defects Research Articles

P27 The platysma myocutaneous flap: another option for oral cavity reconstruction

Introduction The platysma myocutaneous flap have been described by a variety of learned leaders in head and neck surgery. Its advantages includes: thin, pliable and does not require special surgical skill, equipment, or technique to harvest. Methods A retrospective analysis of our experience with 5 patients who received a platysma myocutaneous flap for reconstruction of oral cavity defects is presented. Results Four patients underwent hemiglossectomy and one patient underwent soft palate excision with either radical, modified radical or supraomohyoid neck dissection. In 4 cases the facial artery was spared and in 1 case the facial artery was sacrificed. Only one complication was encountered i.e fistula formation. Adjuvant post-operative radiotherapy was given to 4 patients. The average hospital stay was 11-16 days. Their speech and swallowing function was fairly good. Conclusion These results indicate that the platysma myocutaneous flap is a viable alternative in head and neck reconstruction.

Radial forearm free flap for reconstruction of the oral cavity: clinical experience in 55 cases

Since the advent of modern microvascular techniques, the radial forearm free flap (RFFF) has become a reliable method for reconstruction of defects within the oral cavity. The purpose of the present study was to evaluate our experience with the use of the RFFF for the reconstruction of oral cavity defects after tumor resection. During a 9-year period, 103 consecutive patients were treated in our department for the reconstruction of oral defects after tumoral ablation by means of microvascularized free flaps. Fifty-five patients were reconstructed by means of the RFFF. Patients were treated for benign (n = 1) and malignant (n = 54) entities. All the patients underwent an abdominal split-thickness skin graft for the closure of the donor site. Fifty-five patients underwent reconstruction by means of the RFFF after resection of the oral cavity. Squamous cell carcinoma was present in 54 patients. A mean age of 55.5 years was observed (range 16-78). Thirty-nine patients (70.9%) were men and 16 (29.1%) women. Primary reconstruction was achieved in 52 patients (96.3%). A fasciocutaneous graft was used in all of the cases, with a mean size of 7.39 x 5.17 cm. The mean flap ischemic time was 56.02 minutes. During the immediate follow-up period, revision of the vascular anastomosis was necessary in 18.9% of the cases owing to flap ischemia. Our results revealed that the RFFF is a reliable method for reconstructing a wide range of oral cavity defects with an acceptable low morbidity rate. It provides adequate bulkiness and pliability, resulting in adequate reconstruction of a wide variety of defects within the oral cavity.

Skin grafting in oral cavity reconstruction

Objectives The intent of this article is to help define the role skin grafts have in the reconstruction of oral cavity defects. It also illustrates the technique used and refined over the last 10 years at the authors’ institution. Description Skin grafting remains a very useful method of reconstructing soft tissue defects in the oral cavity. It allows for the reconstruction of the tongue, floor of mouth, buccal mucosa, and maxillectomy defects. Its ability to prevent tethering and preserve tongue mobility is extremely important. This method of reconstruction requires the harvesting of a medium thickness skin graft that is bolstered with sutures into the defect. The need to immobilize the skin graft with a bolster is very important in order to prevent sheering and graft loss. The bolster is then removed after five days, at which time the graft can be assessed. Minimal debridement should be performed initially, and small amounts of graft loss are usually well compensated for; however, complete graft loss will require regrafting of the defect. Conclusion Skin grafting is a very useful method of reconstruction for specific oral cavity defects. The reconstructive technique revolves around a few key principles that are easily learned, and a successful skin graft allows for the preservation of mastication and speech.

Nasolabial flap reconstruction of oral cavity defects: A report of 18 cases

Purpose: This article describes the successful use of pedicled nasolabial flaps in the reconstruction of various oral cavity defects with or without adjunctive microvascular free tissue transfer. Patients and Methods: Twenty-eight flaps were performed in 18 patients, for a variety of oral cavity defects. Results: All flaps healed without evidence of necrosis, infection, or dehiscence. Patient satisfaction with this procedure was high. The use of the nasolabial flap appears to provide an improvement in overall functional outcome. Conclusions: The inferiorly based nasolabial flap provides reliable coverage of intermediate-sized oral cavity defects when used alone. It can improve mastication and speech when used in conjunction with microvascular free tissue transfer for the reconstruction of large combined defects of the tongue and floor of mouth. © 2000 American Association of Oral and Maxillofacial Surgeons

Reconstruction of oral cavity defects with buccinator myomucosal flaps and jejunal flap

Reconstruction of oral cavity defects with buccinator myomucosal flaps and jejunal flap

Versatility of buccinator myomucosal arterial flaps in reconstruction of oral cavity defects

The temporalis muscle flap recently has become widely used in reconstructive surgery of the maxillo-facial region, although it was described around the turn of the century. We review the work which led to its development, and to illustrate its versatility, we describe some of its uses.

Masseter Muscle Crossover Flap in Reconstruction of Oral Defects

Ram M. Tiwari, MD, Amsterdam, recently presented his experience in using a masseter muscle crossover flap to aid in reconstruction of oral cavity defects following tumor ablation. Dr Tiwari reported a series of 26 flaps at the recent fall meeting of the American Academy of Facial Plastic and Reconstructive Surgery in Chicago. Most of the patients in the series had T 2 (16 patients) and T 3 (nine patients) disease without mandibular involvement, but 18 had marginal mandibular resection. He felt this resulted in retraction of the mylohyoid muscle with loss of support to the oral cavity. He raises the masseter flap in a subperiosteal plane, preserving the neural supply, and then attaches it to either the middle constrictor, the tongue, the mylohyoid, or the posterior digastric muscles. He subsequently performs a vestibuloplasty three to six months later and fits dentures. Dr Tiwari feels this provides necessary coverage with good

PECTORALIS MAJOR MUSCLE FLAP WITH AMNION IN ORAL CAVITY RECONSTRUCTION

The pectoralis major myocutaneous flap provides an excellent method for reconstruction of oral cavity defects. This flap has been used since 1978. However, the flap is not without problems. The major problem that has been seen is necrosis of the cutaneous and subcutaneous aspects of the flap. However, in all such instances the muscular portion of the flap survived. This complication was found to occur more commonly in the elderly, diabetics, patients with peripheral vascular disease and patients with excessive adipose or breast tissue superimposed between the cutaneous and muscular components of the flap. In this study the technique of oral cavity reconstruction in the high risk patient group has been modified to avoid using the skin component of the pectoralis major myocutaneous flap. Instead, pectoralis major muscle covered with amnion is used for reconstructive purposes with rapid healing and with very satisfactory functional and cosmetic results.

A modified groin flap for reconstruction of oral cavity defects after tumor resection

A modified groin flap for reconstruction of oral cavity defects after tumor resection

A modified groin flap for reconstruction of oral cavity defects after tumour resection

21 patients, suffering from carcinoma in the lower part of the oral cavity, were operated on by in-continuity resection of the mandible. The removed bone was replaced by a metal plate. The soft tissue defect was completely repaired by a modified free groin flap, transplanted with microsurgical techniques. 19 patients had a complete flap take, two flaps became necrotic. No metal plate was lost during a follow up period of 1-20 months. The functional results in respect of tongue mobility were in all cases quite favourable. Techniques of flap raising and transplantation are outlined in detail.