1
|
Accorona R, Di Furia D, Cremasco A, Gazzini L, Mevio N, Pilolli F, Achena A, Iftikhar H, Awny S, Ormellese GL, Dragonetti AG, De Virgilio A. Oral Reconstruction with Locoregional Flaps after Cancer Ablation: A Systematic Review of the Literature. J Clin Med 2024; 13:4181. [PMID: 39064220 PMCID: PMC11278209 DOI: 10.3390/jcm13144181] [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: 06/05/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Introduction: The planning of oral reconstruction after tumor resection is a pivotal point for head and neck surgeons. It is mandatory to consider two aspects: the size of the surgical defect and the complexity of the oral cavity as an anatomical region. We offer a review of the literature that focuses on four types of locoregional flaps that can be profitably used for such reconstruction: infrahyoid (IF), nasolabial (NF), platysma (PF), and submental (SF). Methods: The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review was carried out according to the PICOS acronym through a comprehensive electronic search on PubMed/MEDLINE, Cochrane Library, and Google Scholar databases. For each selected article, we extrapolated eight main parameters, of which all mean values were compared through an ANOVA test. The dimensions of the oral defects were referred to as "small" (<7 cm2), "medium" (7-50 cm2), or "large" (>50 cm2). Results: A total of 139 articles were selected with a total of 5898 patients. The mean ages for each type of flap were not statistically significant (p = 0.30, p > 0.05). Seven sublocations of oral defects were reported: The most common was the tongue (2003 [34.0%] patients), followed by the floor of the mouth (1786 [30.4%]), buccal mucosa (981 [16.6%]), cheek (422 [7.2%]), hard palate (302 [5.1%]), alveolar ridge (217 [3.7%]), and retromolar trigone (187 [3.2%]). The defects were mainly medium-sized (4507 [76.4%] patients), and fewer were small-sized (1056 [17.9%]) or large-sized (335 [5.7%]). Complications were noted, the most frequent of which was flap necrosis, seen in 0.57% of cases. The functional and esthetical results were mainly positive. Conclusions: Locoregional flaps represent a good alternative in medium-sized defects as well as a fairly good alternative in small- and large-sized defects when other options are ruled out.
Collapse
Affiliation(s)
- Remo Accorona
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Domenico Di Furia
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Alice Cremasco
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Luca Gazzini
- Division of Otorhinolaryngology—Head and Neck Surgery, “San Maurizio” Hospital, 39100 Bolzano, Italy;
| | - Niccolò Mevio
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Francesco Pilolli
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Andrea Achena
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Haissan Iftikhar
- Department of Otorhinolaryngology, University Hospitals Birmingham, Birmingham B75 7RR, UK;
| | - Shadi Awny
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura 35516, Egypt;
| | - Giorgio Luigi Ormellese
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Alberto Giulio Dragonetti
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Armando De Virgilio
- Department of Organ of Sense, Sapienza University of Rome, 00185 Rome, Italy
| |
Collapse
|
2
|
Chakrabarti S, Ghosh A, Bhukkar S, Mishra A. Bilateral Tunnelized FAMM Islanded Flap for Reconstruction of Composite Defect of Tongue and Floor of Mouth: A Case Report. J Maxillofac Oral Surg 2024; 23:49-52. [PMID: 38312956 PMCID: PMC10830930 DOI: 10.1007/s12663-021-01624-y] [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: 03/29/2021] [Accepted: 06/20/2021] [Indexed: 10/20/2022] Open
Abstract
The work of Massarelli et al. is well known for popularizing t-FAMMIF, however to the best of our knowledge bilateral flap has never been harvested and inset together to reconstruct a composite defect. Larger unilateral flaps have been reported in literature but to harvest such a flap in patients of S.E Asian region would entail high propensity for trismus in the post op period as they have tendency for submucosal fibrosis owing to their guthka (chewing tobacco) chewing habits. Oral submucous fibrosis is contra-indication for this flap; however, some of our patients despite being chronic abusers of guthka do not have clinical presentation of OSMF and if the defect post ablation is appropriate are chosen to be candidates for reconstruction with the flap. In this select population harvesting larger flaps can potentially lead to trismus, a fact highlighted in the paper.
Collapse
Affiliation(s)
- Swagnik Chakrabarti
- Department of Head and Neck Surgical Oncology, Homi Bhabha Cancer Hospital, Old Loco Colony, Shivpurwa, Varanasi, Uttar Pradesh 221010 India
| | - Abhishek Ghosh
- Department of Head and Neck Surgical Oncology, Homi Bhabha Cancer Hospital, Old Loco Colony, Shivpurwa, Varanasi, Uttar Pradesh 221010 India
- Bhilai, India
| | - Sandeep Bhukkar
- Department of Head and Neck Surgical Oncology, Homi Bhabha Cancer Hospital, Old Loco Colony, Shivpurwa, Varanasi, Uttar Pradesh 221010 India
| | - Aseem Mishra
- Department of Head and Neck Surgical Oncology, Homi Bhabha Cancer Hospital, Old Loco Colony, Shivpurwa, Varanasi, Uttar Pradesh 221010 India
| |
Collapse
|
3
|
Ullah H, Maqsood A, Faheem S, Khan ZA, Ganji KK, Bashir O, Ahmed N, Heboyan A. Nasolabial Flap in the Management of Oral Sub Mucous Fibrosis: A Series of Cases. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231191030. [PMID: 37547486 PMCID: PMC10402279 DOI: 10.1177/11795476231191030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Abstract
The objective of this study was to evaluate the outcomes of the nasolabial flap in the management of oral submucous fibrosis (OSMF). The descriptive case series included 75 patients diagnosed with OSMF who underwent surgical intervention under general anesthesia. Preoperative mouth opening measurements were compared with postoperative measurements taken after 2 months. Regarding mouth opening, out of the 75 patients, 4 (5.3%) had unsatisfactory results after treatment, while 22 (29.3%) experienced satisfactory outcomes. The majority of patients, 49 (65.3%), achieved normal mouth opening (more than 30 mm) following the Nasolabial flap procedure. This indicates that the Nasolabial flap yielded favorable results in terms of restoring normal mouth opening and benefiting the patients. Based on the findings of this study, the Nasolabial flap was determined to be a viable surgical option for managing oral submucous fibrosis due to its ease of operation, reliable flap vascularity, and low post-operative complication rate. The only drawback identified was the presence of a surgical scar, which can be addressed through secondary correction procedures.
Collapse
Affiliation(s)
- Hidayat Ullah
- District Specialist Dentistry, DHQ Hospital Lower dir Timergrah, Mansehra, Pakistan
| | - Afsheen Maqsood
- Department of Oral Pathology, Bahria University Dental College, Karachi, Pakistan
| | - Samra Faheem
- Department of Oral Pathology, Bahria University Dental College, Karachi, Pakistan
| | - Zafar Ali Khan
- Department of Oral Maxillofacial Radiology & Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Al-Jouf, Kingdom of Saudi Arabia
| | - Kiran Kumar Ganji
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Al-Jouf, Kingdom of Saudi Arabia
| | - Omer Bashir
- Department of Oral and Maxillofacial Surgery, Rehman College of Dentistry, Peshawar, Pakistan
| | - Naseer Ahmed
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| |
Collapse
|
4
|
Mishra A, Shankar R, Prakash G, Banerjee S, Daga D, Birmiwal KG, Tiwari N, Gupta M, Sahu GC, Das A. Transposition nasolabial flap: A versatile flap for sensate reconstruction of lip defects. Head Neck 2022; 44:2473-2480. [PMID: 35920377 DOI: 10.1002/hed.27164] [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: 11/10/2021] [Revised: 07/03/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Lip reconstruction aims at maintaining the function and aesthetics of the facial subunits. Sensation in the reconstructed lip helps in bolus formation, tactile discrimination, and thermal sensation. In this study, we aim to describe random pattern nasolabial flap for lip reconstruction using various functional parameters. METHODOLOGY This is a retrospective study of 22 patients with carcinoma lip who underwent surgical resection and reconstruction with sensate nasolabial flap. Several clinicopathological parameters were studied. Outcome parameters like oral competence, tactile sensation, thermal sensitivity of reconstructed lip and speech outcomes were evaluated. RESULT A functional outcome with 2-4 mm of two-point discrimination was obtained in 19 patients. All patients had intelligible speech. A mean sulcus depth of 19.59 mm was achieved. One patient had partial flap loss owing to wound infection. CONCLUSION Random pattern senate nasolabial flap offers a good functional outcome by maintaining the tactile and thermal sensitivity.
Collapse
Affiliation(s)
- Aseem Mishra
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
| | - Ravi Shankar
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
| | - Gautam Prakash
- Department of Plastic Surgery and Burns Unit, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sudeshna Banerjee
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
| | - Dipti Daga
- Head and Neck Oncology, Netaji Subash Cancer Hospital, Kolkata, India
| | - Krishna Gopal Birmiwal
- Department of Head and Neck Oncology, Acharya Harihar Post Graduate Institute of Cancer, Cuttack, India
| | - Neelesh Tiwari
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
| | - Monika Gupta
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
| | - Guru Charan Sahu
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
| | - Abhishek Das
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
| |
Collapse
|
5
|
Tassone P, Galloway T, Dooley L, Zitsch R. Orocutaneous Fistula After Oral Cavity Resection and Reconstruction: Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2021; 131:880-891. [PMID: 34553635 DOI: 10.1177/00034894211047463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Orocutaneous fistula (OCF) after reconstruction for oral cavity resection can lead to prolonged hospitalization and adjuvant treatment delay. Few studies have examined factors leading to OCF after oral cavity resection. Primary objective: evaluate overall incidence and factors associated with OCF after oral cavity reconstruction. DATA SOURCES Scopus 1960-database was searched for terms: "orocutaneous fistula," "oro cutaneous fistula," "oral cutaneous fistula," "orocervical fistula," "oral cavity salivary fistula." REVIEW METHODS English language studies with >5 patients undergoing reconstruction after oral cavity cancer resection were included. About 1057 records initially screened; 214 full texts assessed; 78 full-texts included. PRISMA guidelines were followed, and MINORS criteria used to assess risk of bias. Data were pooled using random-effects model. Primary outcome was OCF incidence. Meta-analysis to determine the effect of preoperative radiation on OCF conducted on 12 eligible studies. Pre-collection hypothesis was that prior radiation therapy is associated with increased OCF incidence. Post-collection analyses: free versus pedicled flaps; mandible-sparing versus segmental mandibulectomy. RESULTS Seventy-eight studies were included in meta-analysis of overall OCF incidence. Pooled effect size showed overall incidence of OCF to be 7.71% (95% CI, 6.28%-9.13%) among 5400 patients. Meta-analysis of preoperative radiation therapy on OCF showed a pooled odds ratio of 1.68 (95% CI, 0.93-3.06). OCF incidence was similar between patients undergoing free versus pedicled reconstruction, or segmental mandibulectomy versus mandible-sparing resection. CONCLUSION Orocutaneous fistula after oral cavity resection has significant incidence and clinical impact. Risk of OCF persists despite advances in reconstructive options; there is a trend toward higher risk after prior radiation.
Collapse
Affiliation(s)
- Patrick Tassone
- Department of Otolaryngology-Head & Neck Surgery, University of Missouri, Columbia, MO, USA
| | - Tabitha Galloway
- Department of Otolaryngology-Head & Neck Surgery, University of Missouri, Columbia, MO, USA
| | - Laura Dooley
- Department of Otolaryngology-Head & Neck Surgery, University of Missouri, Columbia, MO, USA
| | - Robert Zitsch
- Department of Otolaryngology-Head & Neck Surgery, University of Missouri, Columbia, MO, USA
| |
Collapse
|
6
|
Parwaz MA, Chatterjee P. In Reference to Versatility and Reliability of Islanded Pedicled Nasolabial Flap in Head and Neck Cancer Reconstruction. Laryngoscope 2020; 131:E1103. [PMID: 32809226 DOI: 10.1002/lary.29018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Mohammed A Parwaz
- Department of Plastic Surgery, Army Hospital (R&R), New Delhi, India
| | - Pallab Chatterjee
- Department of Plastic Surgery, Army Hospital (R&R), New Delhi, India
| |
Collapse
|
7
|
Poonia DR, Mujumdar K, Seenivasasgam RK, Galwa R, Agrawal SP. Regarding Versatility and Reliability of Islanded Pedicled Nasolabial Flap in Head and Neck Cancer Reconstruction. Laryngoscope 2020; 130:E500. [PMID: 32557614 DOI: 10.1002/lary.28794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Dharma R Poonia
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | - Kinjal Mujumdar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Rajneesh Galwa
- Department of Plastic Surgery, Dr. SN Medical College, Jodhpur, India
| | - S P Agrawal
- Department of Surgical Oncology (Head & Neck), All India Institute of Medical Sciences, Rishikesh, India
| |
Collapse
|