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Cao LM, Zhong NN, Chen Y, Li ZZ, Wang GR, Xiao Y, Liu XH, Jia J, Liu B, Bu LL. Less is more: Exploring neoadjuvant immunotherapy as a de-escalation strategy in head and neck squamous cell carcinoma treatment. Cancer Lett 2024; 598:217095. [PMID: 38964728 DOI: 10.1016/j.canlet.2024.217095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/15/2024] [Accepted: 06/28/2024] [Indexed: 07/06/2024]
Abstract
Head and neck squamous cell carcinoma (HNSCC) constitutes a significant global cancer burden, given its high prevalence and associated mortality. Despite substantial progress in survival rates due to the enhanced multidisciplinary approach to treatment, these methods often lead to severe tissue damage, compromised function, and potential toxicity. Thus, there is an imperative need for novel, effective, and minimally damaging treatment modalities. Neoadjuvant treatment, an emerging therapeutic strategy, is designed to reduce tumor size and curtail distant metastasis prior to definitive intervention. Currently, neoadjuvant chemotherapy (NACT) has optimized the treatment approach for a subset of HNSCC patients, yet it has not produced a noticeable enhancement in overall survival (OS). In the contemporary cancer therapeutics landscape, immunotherapy is gaining traction at an accelerated pace. Notably, neoadjuvant immunotherapy (NAIT) has shown promising radiological and pathological responses, coupled with encouraging efficacy in several clinical trials. This potentially paves the way for a myriad of possibilities in treatment de-escalation of HNSCC, which warrants further exploration. This paper reviews the existing strategies and efficacies of neoadjuvant immune checkpoint inhibitors (ICIs), along with potential de-escalation strategies. Furthermore, the challenges encountered in the context of the de-escalation strategies of NAIT are explored. The aim is to inform future research directions that strive to improve the quality of life (QoL) for patients battling HNSCC.
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Affiliation(s)
- Lei-Ming Cao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Somatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Nian-Nian Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Somatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Yang Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Somatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Zi-Zhan Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Somatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Guang-Rui Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Somatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Yao Xiao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Somatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Xuan-Hao Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Somatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Jun Jia
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Somatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Somatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Somatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
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Šín P, Hokynková A, Rotschein P, Pejčoch R, Nártová L. Reconstruction of the Tongue after Hemiglossectomy Using Serratus Anterior Muscle Free Flap. Case Rep Otolaryngol 2023; 2023:6637271. [PMID: 37850110 PMCID: PMC10578973 DOI: 10.1155/2023/6637271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
Background Serratus anterior muscle free flap is widely used in numerous indicated reconstructions. Only a few studies have dealt with the use of this flap in tongue reconstruction. Materials and Methods We present a case series of 7 patients with carcinoma of the tongue who underwent hemiglossectomy followed by immediate reconstruction with serratus anterior muscle free flap between January 2017 and December 2019 at the University Hospital Brno. The aim of this study was to evaluate safety and efficiency of the reconstruction as well as the donor site morbidity. Results There was not a single case of flap failure observed and the donor site healed completely in all cases. The functional outcome (tongue mobility, phonation, and deglutition) depended on the severity of the primary oncological disease and health status of the patient. Conclusion The serratus anterior muscle free flap represents an alternative option for reconstruction of the tongue.
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Affiliation(s)
- Petr Šín
- Department of Burns and Plastic Surgery, University Hospital Brno, Czech Republic Jihlavská 20, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University Brno, Czech Republic Kamenice 5, 625 00 Brno, Czech Republic
| | - Alica Hokynková
- Department of Burns and Plastic Surgery, University Hospital Brno, Czech Republic Jihlavská 20, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University Brno, Czech Republic Kamenice 5, 625 00 Brno, Czech Republic
| | - Pavel Rotschein
- Department of Burns and Plastic Surgery, University Hospital Brno, Czech Republic Jihlavská 20, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University Brno, Czech Republic Kamenice 5, 625 00 Brno, Czech Republic
- Clinic of Pediatric Surgery, Orthopedics and Traumatology, University Hospital Brno, Czech Republic Jihlavská 20, 625 00 Brno, Czech Republic
| | - Radek Pejčoch
- Department of Otorhinolaryngology, University Hospital Brno, Czech Republic Jihlavská 20, 625 00 Brno, Czech Republic
| | - Lucie Nártová
- Department of Burns and Plastic Surgery, University Hospital Brno, Czech Republic Jihlavská 20, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University Brno, Czech Republic Kamenice 5, 625 00 Brno, Czech Republic
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Araki J, Mori K, Yasunaga Y, Onitsuka T, Yurikusa T, Sakuraba M, Higashino T, Hashikawa K, Ishida K, Sarukawa S, Hamahata A, Kimata Y, Matsumoto H, Terao Y, Yokogawa H, Sekido M, Asato H, Miyamoto S, Hyodo I, Nakagawa M. A Novel Risk Model for Predicting Dysphagia after Tongue Reconstruction: A Retrospective Multicenter Study in Japan. Plast Reconstr Surg 2023; 152:693e-706e. [PMID: 36942956 PMCID: PMC10521771 DOI: 10.1097/prs.0000000000010428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/11/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND There is no consensus on the postoperative outcomes of tongue reconstruction. Therefore, the authors developed a novel risk model for predicting dysphagia after tongue reconstruction. METHODS This retrospective study was conducted by the Oral Pharyngeal Esophageal Operation and Reconstruction Analytical, or OPERA, group across 31 cancer centers and university hospitals in Japan. A total of 532 patients [390 (73.3%) men and 142 (26.7%) women; median age at surgery, 60 years (range, 15 to 88 years)] who were diagnosed with oral tongue squamous cell carcinoma and underwent tongue reconstruction following glossectomy between 2009 and 2013 were included. Independent risk factors were identified using univariate regression analysis and converted to a binary format for multivariate analysis. An integer value was assigned to each risk factor to calculate a total score capable of quantifying the risk of feeding tube dependence. RESULTS Overall, 54 patients (10.2%) required a feeding tube at the time of evaluation. Predictive factors for feeding tube dependence were advanced age, lower American Society of Anesthesiologists physical status, low body mass index, lower serum albumin, comorbid hypertension and diabetes, extended tongue defect, resection beyond the tongue, laryngeal suspension, postoperative radiation therapy, and no functional teeth. In multivariate logistic regression analysis, age greater than or equal to 58.5 years, postoperative radiation therapy, wider tongue defect, and body mass index less than 21.27 kg/m 2 earned 6, 4, 3, and 2 points, respectively, for a maximum total score of 15. CONCLUSION The authors' risk model provides a mathematical tool for estimating the individual risk of postoperative feeding tube dependence before tongue reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Jun Araki
- From the Division of Plastic and Reconstructive Surgery
| | | | | | | | - Takashi Yurikusa
- Division of Dentistry and Oral Surgery, Shizuoka Cancer Center Hospital
| | - Minoru Sakuraba
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East
- Department of Plastic and Reconstructive Surgery, Iwate Medical University
| | - Takuya Higashino
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East
| | | | - Katsuhiro Ishida
- Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine
| | | | - Atsumori Hamahata
- Department of Plastic and Reconstructive Surgery, Saitama Cancer Center
| | - Yoshihiro Kimata
- Department of Plastic and Reconstructive Surgery, Okayama University Hospital
| | - Hiroshi Matsumoto
- Department of Plastic and Reconstructive Surgery, Okayama University Hospital
| | - Yasunobu Terao
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
| | - Hideki Yokogawa
- Department of Plastic and Reconstructive Surgery, Saitama Medical University International Medical Center
| | - Mitsuru Sekido
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba
| | - Hirotaka Asato
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University School of Medicine
| | - Shimpei Miyamoto
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital
| | - Ikuo Hyodo
- Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital
| | - Masahiro Nakagawa
- From the Division of Plastic and Reconstructive Surgery
- Department of Plastic Reconstructive Surgery, Hamamatsu University School of Medicine
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Woo SH, Kim YC, Jeong WS, Oh TS, Choi JW. Three-Dimensional Analysis of Flap Volume Change in Total Tongue Reconstruction: Focus on Reinnervated Dynamic Tongue Reconstruction. J Craniofac Surg 2023; 34:2056-2060. [PMID: 37639671 DOI: 10.1097/scs.0000000000009694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
In general, flap volume decreases over time and further in the case of a denervated muscle flap. In our institution, dynamic reconstruction, including functional muscle flaps, has been used to aid functional recovery in the past 6 years. This study aimed to determine the effect of volume change of the fat and muscular sections of reconstructed tongue flaps after motor nerve reinnervation in dynamic total tongue reconstruction using 3-dimensional measurement and analysis. A retrospective chart review was performed on 21 patients who underwent total tongue reconstruction using an anterolateral thigh free flap from 2015 to 2020. The fat and muscle volumes of the flap were measured using computed tomography data obtained before surgery (T0), 2 weeks after surgery (T1), and 6 months after surgery (T2) using a 3-dimensional rendering software. Among the 21 patients that underwent tongue reconstruction, 10 underwent dynamic reconstruction, whereas 11 underwent conventional reconstruction using a fasciocutaneous flap. T2 volume compared with T1 was 69.08% in the conventional reconstruction group, and the fat and muscle portions in the dynamic reconstruction group were 77.04% and 69.06%, respectively. No significant difference was noted in the volume change between the 2 groups. After dynamic tongue reconstruction, the muscular volume of the flap had similar volume reduction rate as the fat volume. The dynamic reconstruction was effective not only for functional muscle transfer but also for maintaining the volume of the reconstructed muscle flap.
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Affiliation(s)
- Soo Hyun Woo
- Department of Plastic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine
| | - Young Chul Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Shik Jeong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Suk Oh
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Woo Choi
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim YC, Woo SH, Jeong WS, Oh TS, Choi JW. Impact of Dynamic Tongue Reconstruction on Sequential Changes of Swallowing Function in Patients Undergoing Total or Near-Total Glossectomy. Ann Plast Surg 2023; 91:257-264. [PMID: 37489967 DOI: 10.1097/sap.0000000000003629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
PURPOSE This study aimed to compare the effects of motor-innervated free flap on sequential changes of swallowing function in patients undergoing total or near-total glossectomy with laryngeal preservation. MATERIALS AND METHODS The medical charts of 21 patients who underwent tongue reconstruction after total or near-total glossectomy between April 2015 and December 2020 were retrospectively reviewed. Patients were divided into groups by reconstruction type: conventional, reconstruction using an anterolateral thigh free flap (n = 11), and dynamic, reconstruction using an anterolateral thigh with innervated vastus lateralis flap (n = 10). Demographics, surgical details, and survival outcomes were investigated. A videofluoroscopic penetration-aspiration scale and functional outcome swallowing scale were analyzed according to postoperative time courses, classified as within 6 months, 6 to 12 months, and after 12 months postoperative. A time-to-event analysis was performed for gastrostomy tube status. RESULTS The dynamic group showed improved swallowing outcomes at 6 to 12 months postoperative (dynamic vs conventional group, penetration-aspiration scale: 3 ± 1.51 vs 6 ± 1.63, P = 0.024; functional outcome swallowing scale: 1.89 ± 1.36 vs 4 ± 1.41, P = 0.009). In the multivariate analysis, the dynamic group showed a decreased probability of decompensated swallowing function at 6 to 12 months postoperative (odds ratio, 0.062; 95% confidence interval, 0.004-1.084; P = 0.057). A time-to-event analysis revealed no significant difference in gastrostomy tube status between the dynamic and the conventional group. CONCLUSIONS Considering higher mortality in patients subjected to total or near-total glossectomy, dynamic reconstruction with motor-innervated free flap is worth to perform in terms of enhancing the swallowing function within 1-year postoperative period, thereby improving the quality of life.
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Affiliation(s)
- Young Chul Kim
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, SeoulAsan Medical Center, Seoul, Korea
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Quadri P, McMullen C. Oral Cavity Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00048-8. [PMID: 37164898 DOI: 10.1016/j.otc.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This summary provides a concise overview of oral cavity reconstruction to optimize functional outcomes in the modern era. Soft tissue and osseous reconstruction options for a wide range of oral cavity sites including lip, oral tongue, floor of mouth, buccal, hard palate, and composite oromandibular resections are reviewed. The appropriate applications of primary closure, secondary intention, skin grafts, and dermal substitute grafts are included. Anatomic considerations, indications, contraindications, and complications of local, regional, and free flaps in oral cavity reconstruction are discussed. Specific defects and the appropriate options for reconstruction of those defects are delineated.
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Affiliation(s)
- Pablo Quadri
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB - 6 Floor, Tampa, FL 33612, USA
| | - Caitlin McMullen
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB - 6 Floor, Tampa, FL 33612, USA.
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Russo E, Alessandri-Bonetti M, Costantino A, Festa BM, Egro FM, Giannitto C, Spriano G, De Virgilio A. Functional outcomes and complications of total glossectomy with laryngeal preservation and flap reconstruction: A systematic review and meta-analysis. Oral Oncol 2023; 141:106415. [PMID: 37149955 DOI: 10.1016/j.oraloncology.2023.106415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To analyze the functional outcomes and complications of total glossectomy with laryngeal preservation and reconstruction with free or pedicled flaps. METHODS A search was conducted using Pubmed/MEDLINE, Cochrane Library, Scopus, and Google Scholar databases. A single arm meta-analysis was performed for feeding tube dependence (FTD), tracheostomy dependence (TD), and speech intelligibility (SI) rates. Peri-operative sequels and complications were evaluated as secondary outcomes. RESULTS A total number of 642 patients (median age: 54.2 years; 95% CI 52.1-58) were included. Functional assessment was performed after a median of 12 months (n = 623/642; 95% CI 10.6-12). Overall, the cumulative FTD rate was 22.9% (n = 188/627; 95% CI 10.2-38.7), the TD rate was 7.3% (n = 95/549; 95% CI 1.9-15.8), and the SI was 91.1% (n = 314/409; 95% CI 80.7%-97.8). The cumulative complication rate was 33.1% (n = 592/642). Eighteen patients (n = 18/592; 3.0%) experienced a major fistula, while aspiration pneumonia occurred in 17 cases (n = 17/592; 2.8%). CONCLUSIONS Total glossectomy with laryngeal preservation and pedicled/free flaps reconstruction may guarantee good functional results and an acceptable quality of life. Further prospective studies are advised to define clinical guidelines about proper patients' and flaps' selection.
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Affiliation(s)
- Elena Russo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Mario Alessandri-Bonetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milan, Italy
| | - Andrea Costantino
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
| | - Bianca Maria Festa
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Francesco Maria Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Caterina Giannitto
- Radiology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
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Kim YC, Lee SJ, Park H, Choi YJ, Jeong WS, Lee YS, Choi KH, Oh TS, Choi JW. Swallowing analysis in hemi-tongue reconstruction using motor-innervated free flaps: A cine-magnetic resonance imaging study. Head Neck 2023; 45:1097-1112. [PMID: 36840932 DOI: 10.1002/hed.27309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 11/06/2022] [Accepted: 01/12/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND This study aimed to explore the outcomes of motor-innervated free flaps in hemi-tongue reconstruction by assessing the tongue mobility through midsagittal images from cine-magnetic resonance imaging. METHODS In this retrospective study, 47 patients who underwent tongue reconstruction following hemi-glossectomy and 10 control subjects without any surgical history were included. Patients were classified into two groups: the motor and no-motor innervation group. Various spatial parameters related to tongue mobility that were acquired from midsagittal sections were compared during consecutive swallowing phases. RESULTS Overall, the motor group showed improved functional swallowing scale compared with the no-motor group. In case of tongue base resection, the motor group showed improved mobility of the tongue base during pharyngeal phase, whereas the no-motor group showed increased laryngeal elevation for compensatory movement. CONCLUSION The tongue reconstruction with motor-innervated free flaps may facilitate swallowing capacity in patients with a hemi-tongue defect combined with tongue base resection.
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Affiliation(s)
- Young Chul Kim
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Seok Joon Lee
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Hojin Park
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo Shik Jeong
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Yoon Se Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Suk Oh
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
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Watarai A, Yasunaga Y, Nakao J, Mori H, Araki J, Ishii Y, Yonezawa M, Kakinuma S, Mukaigawa T, Kadomatsu K. Groin and anterolateral thigh flaps for hemiglossectomy reconstruction: A comparison based on Japanese speech intelligibility. Auris Nasus Larynx 2023; 50:110-118. [PMID: 35597697 DOI: 10.1016/j.anl.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The differences in speech function between groin flap reconstruction and anterolateral thigh (ALT) flap reconstruction after hemiglossectomy have not been clarified to date. This study aimed to compare Japanese speech intelligibility after hemiglossectomy reconstruction using groin and ALT flaps of similar thickness. METHODS Data of patients who underwent hemiglossectomy reconstruction with groin or ALT flaps between April 2010 and March 2020 were collected from the medical chart database. The ALT flap was the first choice for hemiglossectomy reconstruction, and a groin flap was used when the ALT flap was >10 mm. Cases in which speech intelligibility assessments based on Hirose's 10-point scoring system, the TKR speech test, and the Japanese speech intelligibility test for 100 monosyllables were performed after 6 months postoperatively were extracted. The per-patient scores for each assessment were initially compared between the two flap groups. Then, the results of the Japanese speech intelligibility test for 100 monosyllables were reanalyzed on a syllable-by-syllable basis. RESULTS Among the 44 hemiglossectomy patients who underwent free-flap reconstruction during the study period, 14 (seven each in the groin flap and ALT flap groups) underwent all three conventional speech intelligibility assessments after 6 months postoperatively. The two groups showed no significant difference in postoperative speech intelligibility in any of the three patient assessment methods. However, in intergroup comparisons based on per-syllable accuracy for each of the 100 monosyllables, the groin flap group showed 19 syllables with a significantly higher accuracy, whereas the ALT flap group showed one such syllable. In particular, five out of the six alveolar consonants (/t/ and /d/) were more accurately articulated in the groin flap group. Per-syllable accuracy was significantly higher in the groin flap group (74.6% vs. 66.7%; 95% confidence interval: 4.6-11.1, p < 0.001). CONCLUSION In patients undergoing hemiglossectomy reconstruction, our new analysis method, which compared intelligibility by syllables, showed that the groin flap yielded higher speech intelligibility than the ALT flap. This difference was evident at all four articulation points involving the tongue, whereas there was no significant difference at the two articulation points without tongue involvement.
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Affiliation(s)
- Aya Watarai
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan; Department of Plastic and Reconstructive Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Yoshichika Yasunaga
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan.
| | - Junichi Nakao
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Hiroaki Mori
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Jun Araki
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Yoshitaka Ishii
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Minami Yonezawa
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Shota Kakinuma
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Takashi Mukaigawa
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Koichi Kadomatsu
- Department of Plastic and Reconstructive Surgery, Showa University School of Medicine, Tokyo, Japan
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Role of reinnervation in the functional outcomes after glossectomy reconstruction. Int J Oral Maxillofac Surg 2022; 52:620. [PMID: 36075835 DOI: 10.1016/j.ijom.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/09/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022]
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Chiesa-Estomba CM, González-García JÁ, Piazza C, Mayo-Yanez M, Grammatica A, Lechien JR, Din TF, Karkos P, García-Iza L, Ayad T. Gracilis free flap in head and neck reconstruction beyond facial palsy reanimation. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chiesa-Estomba CM, González-García JÁ, Piazza C, Mayo-Yanez M, Grammatica A, Lechien JR, Din TF, Karkos P, García-Iza L, Ayad T. Gracilis free flap in head and neck reconstruction beyond facial palsy reanimation. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:310-322. [PMID: 36113921 DOI: 10.1016/j.otoeng.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/05/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The gracilis muscle free flap has gained popularity in head and neck reconstruction due to minimal donor-site morbidity, reliable vascular pedicle, strong muscular component, and possibility to perform nerve coaptation. However, almost all the existing evidence in the literature is related to its use for facial palsy reanimation. The aim of this study was therefore to review and provide a comprehensive summary of all the possible indications and outcomes of this versatile free flap in head neck reconstructive surgery. MATERIALS AND METHODS A systematic review of the literature was conducted including articles from 1970 to 2019. All articles were examined and described. RESULTS Twenty-seven papers published between 1994 and 2019 were identified for analysis. The evidence highlights the use of the gracilis muscle free flap for parotid, forehead and midface defects, oral tongue, oral sphincter, lower and upper lip, cheek, and oral commissure defects, among others, as the most common defects reconstructed. CONCLUSION This flap represents an easy to harvest and versatile free flap with low donor-site morbidity and multiple proven uses in head & neck reconstruction. We therefore encourage reconstructive surgeons to include this flap in their armoury, either as a first or as a second-line option.
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Affiliation(s)
- Carlos Miguel Chiesa-Estomba
- Otorhinolaryngology - Head & Neck Surgery Department, Hospital Universitario Donostia, San Sebastian, Guipuzkoa - Basque Country, Spain; Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France.
| | - José Ángel González-García
- Otorhinolaryngology - Head & Neck Surgery Department, Hospital Universitario Donostia, San Sebastian, Guipuzkoa - Basque Country, Spain
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Miguel Mayo-Yanez
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Galicia, Spain; Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France
| | - Alberto Grammatica
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Jerome R Lechien
- Department of Human Anatomy & Experimental Oncology, University of Mons, Mons, Belgium; Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France
| | - Taseer F Din
- Division of Otolaryngology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Petros Karkos
- Department of Otolaryngology - Head Neck Surgery, Ahepa University Hospital, Thessaloniki, Greece
| | - Leire García-Iza
- Otorhinolaryngology - Head & Neck Surgery Department, Hospital Universitario Donostia, San Sebastian, Guipuzkoa - Basque Country, Spain
| | - Tareck Ayad
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada; Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France
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Choi JW, Kim YC, Park HJ, Oh TS, Jeong WS. The impact of dynamic tongue reconstruction using functional muscle transfer: A retrospective review of 94 cases with functional outcome analysis for various glossectomy defects. J Craniomaxillofac Surg 2022; 50:719-731. [DOI: 10.1016/j.jcms.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 07/09/2022] [Accepted: 07/16/2022] [Indexed: 10/16/2022] Open
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Park H, Park JS, Jeong WS, Choi JW. Dynamic Hemitongue Defect Reconstruction With Functional Gracilis Muscle Free Transfer. Ann Plast Surg 2021; 86:308-316. [PMID: 33555685 DOI: 10.1097/sap.0000000000002555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Because the tongue consists of 26 intrinsic and extrinsic muscles, even hemiglossectomy, which preserves some of the tongue and its muscles, leads to functional morbidity in speech and swallowing. Subsequent reconstruction using a conventional fasciocutaneous flap results in limited functional recovery. This study compared the functional recovery of patients who underwent hemiglossectomy based on the fasciocutaneous free flap with or without dynamic gracilis muscle flap reconstruction. METHODS Twenty-three patients were included in the study. Reconstruction was achieved using radial forearm and gracilis conjoined flaps (n = 7), gracilis flaps (n = 7), and radial forearm flaps (RFFFs) (n = 9) between 2014 and 2019. Functional outcome data were collected via videofluoroscopic swallowing, speech analysis, and a tongue movement scale. RESULTS In the conjoined flap group, the lingual range of motion in terms of elevation and defect-side lateralization was superior to that of the RFFF group. Furthermore, the conjoined flap was associated with superior protrusion, elevation, and lateralization (on both sides) than the gracilis-only flap. Patients who underwent conjoined-flap reconstruction had better articulation, intelligence, and dysphagia outcomes than patients who underwent reconstruction with RFFFs or gracilis-only flaps. CONCLUSIONS Although this was a preliminary study, the findings suggest that using a conjoined free flap with an RFFF and a functional gracilis muscle flap for dynamic hemitongue reconstructions could improve postoperative tongue function.
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Affiliation(s)
- Hojin Park
- From the Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Korea
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Hammond JB, Teven CM, Flug JA, Jokerst CE, Howarth AL, Shrout MA, Laitinen MA, Foley BM, Kruger EA, Casey WJ, Rebecca AM. The Chimeric Gracilis and Profunda Artery Perforator Flap: Characterizing This Novel Flap Configuration with Angiography and a Cadaveric Model. J Reconstr Microsurg 2021; 37:617-621. [PMID: 33592634 DOI: 10.1055/s-0041-1723824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A chimerically configured gracilis and profunda artery perforator (PAP) flap is highly prevalent based on recent computed tomography (CT)-imaging data. The purpose of this study is to further characterize the vascular anatomy of this novel flap configuration and determine the feasibility of flap dissection. METHODS To characterize flap arterial anatomy, lower extremity CT angiograms performed from 2011 to 2018 were retrospectively reviewed. To characterize venous anatomy and determine the feasibility of flap harvest, the lower extremities of cadavers were evaluated. RESULTS A total of 974 lower extremity CT angiograms and 32 cadavers were included for the assessment. Of the 974 CT angiograms, majority (966, 99%) were bilateral studies, yielding a total of 1,940 lower extremities (right-lower-extremity = 970 and left-lower-extremity = 970) for radiographic evaluation. On CT angiography, a chimerically configured gracilis and PAP flap was found in 51% of patients (n = 494/974). By laterality, chimeric anatomy was present in 26% of right lower extremities (n = 254/970) and 25% of left lower extremities (n = 240/970); bilateral chimeric anatomy was found in 12% (n = 112/966) of patients. Average length of the common arterial pedicle feeding both gracilis and PAP flap perforasomes was 31.1 ± 16.5 mm (range = 2.0-95.0 mm) with an average diameter of 2.8 ± 0.7 mm (range = 1.3-8.8 mm).A total of 15 cadavers exhibited chimeric anatomy with intact, conjoined arteries and veins allowing for anatomical tracing from the profunda femoris to the distal branches within the tissues of the medial thigh. Dissection and isolation of the common pedicle and distal vessels was feasible with minimal disruption of adjacent tissues. Chimeric flap venous anatomy was favorable, with vena commitante adjacent to the common pedicle in all specimens. CONCLUSION Dissection of a chimeric medial thigh flap consisting of both gracilis and PAP flap tissues is feasible in a cadaveric model. The vascular anatomy of this potential flap appears suitable for future utilization in a clinical setting.
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Affiliation(s)
| | - Chad M Teven
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, Arizona
| | | | | | - Ashley L Howarth
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, Arizona
| | - Max A Shrout
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, Arizona
| | | | | | - Erwin A Kruger
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, Arizona
| | - William J Casey
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, Arizona
| | - Alanna M Rebecca
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, Arizona
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Heredero S, Falguera-Uceda MI, Sanjuan-Sanjuan A, Dean A, Solivera J. Chimeric profunda artery perforator - gracilis flap: A computed tomographic angiography study and case report. Microsurgery 2020; 41:250-257. [PMID: 33332622 DOI: 10.1002/micr.30694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/07/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The possibility of harvesting the profunda artery perforator (PAP) flap in a chimeric configuration together with the innervated gracilis muscle may be a good option for dynamic reconstruction following total glossectomies. In this paper, we present a retrospective radiological study, which evaluates the presence and characteristics of the anatomical variation of the chimeric PAP - gracilis flap. METHODS The study sample comprised 66 patients (132 legs), 38 men, and 28 women with an average age of 56 ± 2 years old, who underwent head and neck reconstruction with a free flap. Preoperative computed tomographic angiography (CTA) was used for morphologic analysis. We present a case report of a patient with a total glossectomy reconstructed with this flap. RESULTS A perforator in the PAP area joining with the main pedicle of the gracilis muscle was found in 38 legs (28.8%). Mean length of the pedicle from the profunda femoral artery to the point where the perforator in the PAP area and the pedicle of the gracilis joined was 3.0 ± 0.3 cm. Differences in the existence of this vascular configuration were not significant comparing groups by sex, BMI, height, side or source vessel. Motion of the new tongue was documented clinically and with electromyography. The patient achieved an intelligible speech and normal diet. CONCLUSIONS Preoperative evaluation is necessary to assess the existence of a perforator in the PAP area joining with the main pedicle of the gracilis muscle. This chimeric flap has been demonstrated useful for dynamic reconstruction of a patient with a total glossectomy.
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Affiliation(s)
- Susana Heredero
- UGC de Cirugía Maxilofacial, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | | | - Alicia Dean
- UGC de Cirugía Maxilofacial, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Juan Solivera
- UGG de Neurocirugía, Hospital Universitario Reina Sofía, Córdoba, Spain
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Polyakov AP, Mordovskiy AV, Ratushnyy MV, Rebrikova IV. Functional tongue and floor of mouth reconstruction with a chimeric flap after total glossectomy. Oral Maxillofac Surg 2020; 25:271-277. [PMID: 32926265 DOI: 10.1007/s10006-020-00907-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Presently, the functional reconstruction of the tongue in patients after subtotal or total glossectomy with the removal of the oral floor muscles and spearing of the larynx remains a complicated and unsolved issue. The aim of this case is to describe a method reconstruction of the tongue in patients after total glossectomy with the removal of the oral floor muscles using the chimeric latissimus dorsi and serratus anterior free flap (chimeric LD + SA flap) with motor innervation. METHODS A 62-year-old woman with advanced cancer of the oral cavity was submitted to total glossectomy and then reconstruction with a chimeric LD + SA flap. With this method reconstruction of the tongue was made the creation a large mound (neotongue) lateral to the mandibular arch which can easily reach the palatal arch and also was made suspension of the larynx is essential given the ablative loss of supra-hyoid attachments. RESULTS Our preliminary experience shows that this flap is a good reconstructive option for total glossectomy with the removal of the oral floor muscles and with larynx preservation. Functional and objective evaluation of the tongue reconstructed with chimeric LD + SA free flap requires further and standardized evaluation.
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Affiliation(s)
- Andrey P Polyakov
- P. Hertsen Moscow Oncology Research Institute, National Medical Research Center for Radiology, Russian Ministry of Health, 2-nd Botkinsky 3, Moscow, Russia
| | - Alexander V Mordovskiy
- P. Hertsen Moscow Oncology Research Institute, National Medical Research Center for Radiology, Russian Ministry of Health, 2-nd Botkinsky 3, Moscow, Russia.
| | - Mikhail V Ratushnyy
- P. Hertsen Moscow Oncology Research Institute, National Medical Research Center for Radiology, Russian Ministry of Health, 2-nd Botkinsky 3, Moscow, Russia
| | - Irina V Rebrikova
- P. Hertsen Moscow Oncology Research Institute, National Medical Research Center for Radiology, Russian Ministry of Health, 2-nd Botkinsky 3, Moscow, Russia
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Ferrari M, Sahovaler A, Chan HH, Nicolai P, Irish JC, Gilbert RW. Scapular tip-thoracodorsal artery perforator free flap for total/subtotal glossectomy defects: Case series and conformance study. Oral Oncol 2020; 105:104660. [DOI: 10.1016/j.oraloncology.2020.104660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/08/2020] [Accepted: 03/18/2020] [Indexed: 12/09/2022]
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