[Changes in oral mucosa and tumors in elderly patients]

Intraoral and perioral tissues demonstrate exemplary age-related atrophic changes that are due to endogenous factors, as well as to exogenic damage. Age-related physiological changes in intraoral mucosa, salivary glands, tongue, musculature, and the nerve system are discussed. Pathological changes in the mucosa, especially the different types of leukoplakia are demonstrated; they play a crucial role in the early diagnosis of intraoral cancer. The development of intraoral cancer is very much related with age. Age-related changes of oral mucosa increase the risk of cancer, and the risk is further increased by the long-term influence of exogenic damages. Surgery is the treatment of choice, especially in the elderly patient, in whom quality of life must be maintained as much as possible. The prognosis of intraoral cancer is mainly influenced by the size of the tumor at treatment. Therefore, early diagnosis and prophylaxis, which is often neglected in elderly patients, may improve this situation.

Reconstruction of large defects in the oropharynx with a revascularized intestinal graft: an experimental and clinical report

Our experimental investigation in six mongrel dogs with free revascularized jejunal loop for intraoral lining shows functional adaptation of the small bowel mucosa clinically and histologically. Although 1 year after transplantation 70 percent or more of the graft's surface remains small bowel mucosa, the flattening and widening of the villi produces an epithelial layer that satisfies the conditions of the oropharynx. In 30 clinical cases with a follow-up period of over 4 years our experimental experience is confirmed. After extensive ablative surgery in the oropharynx, primary reconstruction with free revascularized jejunal loop in combination with mandibular replacement has some significant advantages: There is no cicatricial induration of the graft. Mucus production occurs. Flexibility of the grafts and almost unlimited transplant supply lead to satisfying reconstruction even in difficult anatomic sites. Mesenteric fat tissue serves as good transplant material for extended soft-tissue loss. There is good wound healing, owing to abundant blood supply and prompt agglutination of the serosa. The long vascular pedicle provides revascularization apart from the resection area, which is important in irradiated cases. Decreased mucus production after 2 hours of normothermic ischemia and the anatomic reconstruction of mandibular replacement make tracheostomy not necessary.

Experimental study on the free transplantation of mucosa and lyophilised dura to the oral cavity

The covering of epithelial defects in the oral cavity presents special problems in preprosthetic surgery, since special requisites for function and quality of mucosal grafts must be satisfied. In animal experiments mucosal defects in the oral cavity of 30 rabbits were repaired with free transplants of autologous mucosa and heterologous lyophilised dura. A comparative clinical and histological assessment of the healing processes showed that there was no essential difference between both methods. Considering the necessary second intervention, the infliction of a second wound, as well as the limited source of mucosa, our results show that the use of lyophilised dura in preprosthetic surgery is preferable.