Oral functional outcome after intraoral reconstruction with nasolabial flaps

Utility of Single-Stage Nasolabial Flap Reconstruction for Oral Cavity Defects Following Surgery for Oral Cancers and Premalignant Lesions: A Clinical Audit

An inferiorly based nasolabial flap (NLF) is a versatile flap for various oral cavity defects. However, it generally necessitates a second stage procedure to release the base at 3 weeks following the initial surgery. Reconstruction for oral cavity defects can be done with the inferiorly based nasolabial flap as a single-stage procedure. In this retrospective clinical audit, we analyzed patients who underwent an inferiorly based NLF reconstruction for oral cavity defect from January 2016 to September 2021. We analyzed the various defects for which this flap was used along with the associated complications and the safety of performing this flap in terms of its flap-related complications and the histopathological features such as margins. Forty-four patients underwent this inferiorly based single-stage NLF. The median age of the patients in the cohort was 56 years, with the majority being men (n = 38, 86.4%). Buccal mucosa and lip were the most common sites of the primary. Twenty-nine patients were per primam and 15 were recurrent cancers. Most had T1 (n = 14, 31.8%) and T2 (n = 19, 43.2%) cancers. The median closest margin was 6 mm and the base was 7 mm. There were no flap losses; however, 6 patients had minor wound breakdown for which secondary suturing was needed. Single-stage NLF is a safe flap that could be considered in select patients for appropriate oral cavity defects.

Reconstruction of complex oro-mandibular defects by four different modifications of free fibula osteomyocutaneous flap: A prudent alternative to multiple flaps

INTRODUCTION

Resection of advanced oral squamous cell carcinoma results in complex oro-mandibular defects involving external skin, oral mucosa, and bone. Reconstruction of such defects by a single free fibula flap (FFF) is limited by the lack of soft tissue bulk and adequate skin paddle for both intra- and extra-oral coverage. In this study, the reconstruction of large defects was achieved by four modifications of free fibula osteomyocutaneous flap as an alternative to multiple flaps.

METHODS

In this prospective study, 29 patients with complex oro-mandibular defects were reconstructed by FFF from December 2018 to October 2020. Reconstruction was done with any one of the four FFF modifications involving large proximal skin paddle from lateral leg: Strip de-epithelialization (De-Ep), chimeric bipaddle (Ch-Bp), muscle orally and skin extra-orally (Mo-Se), and double microvascular (Db-Mi). Outcome variables assessed were functional and esthetic results, early/late complications, donor site morbidity, and operative time. An algorithm based on Cordeiro's classification is proposed to assist in the selection of appropriate FFF modification.

RESULTS

Among 29 patients, De-Ep was used in 13, Ch-Bp in 8, Mo-Se in 7, and Db-Mi in 1 case. None of the flaps underwent total loss. Two cases required re-exploration. The median operative time was 775 min. Wound dehiscence and oro-cutaneous fistula were common early and late complications, respectively. Partial split skin graft loss (SSG) was the most common donor site morbidity. Functional and facial aesthetics were acceptable at the end of follow-up.

CONCLUSIONS

Specific FFF modifications can be recommended in selected scenarios. It is reliable for single-stage reconstruction with satisfactory esthetic and functional outcomes. When used for reconstruction in first primary tumors, the second donor site is preserved, which can prove valuable in the event of a recurrence or second primary.

Modified nasolabial flap- the nasomentolabial flap: A new arrow in surgeon's quiver

AIMS AND OBJECTIVES

To describe an inferior extension of a naso-labial flap as an adjunct to a maleo-labial flap in reconstruction of complete thickness defects around the oral commissure in 2 cases that we performed at our institute.

METHODS

Two elderly cases of carcinoma buccal mucosa who underwent wide local excision along with neck dissection had moderately large peri-oral defects that are large to cover with nasolabial flap alone. An inferior extension to the maleo-labial flap was added, making it a naso-mento-labial flap to reconstruct the defects with an acceptable outcome aesthetically and functionally. The reconstructed defects' size was around 7 × 7cms and 8.5 × 6cms full-thickness defect in the buccal mucosa, respectively, with the extension of the defect in both the patients being almost the same with anterior extension to commissure, posteriorly to retro-molar trigone (RMT), laterally full-thickness, medially not involving alveolus.

RESULTS

The incision at the donor site was closed primarily. The reconstruction did achieve the patient acceptable aesthetics, functionality, color and texture. The mean follow up of the patients is around 1 year with no complications.

CONCLUSION

Naso-mento-labial flap, an inferiorly extended inferiorly based nasolabial flap is a useful addition to surgeon's armamentarium for reconstructing the buccal mucosa and peri-oral defects in patients whose general health prevents the using pedicled or free flaps.

The Versatility of Nasolabial Flaps in Maxillofacial Surgery

Introduction

The nasolabial flap can be used for reconstruction of the orofacial region. The procedure is of a short duration and treats orofacial soft tissue defects of small to moderate size, especially when microsurgical free flaps are less feasible due to lack of infrastructure, expertise or financial constraints.

Aims and Objectives

To study the effectiveness of the nasolabial flaps in reconstruction of orofacial defects of various origins.

Materials and Methods

In this prospective study, 10 patients (18 nasolabial flaps) were selected randomly regardless of age, sex and need for reconstruction-whether it being requirement of tissue coverage following traumatic loss of soft tissue, soft tissue coverage after resection of a benign or malignant tumor, or resection of soft tissue defects after excision of submucous fibrosis bands. Patients were treated under general anesthesia following routine investigations, using either inferiorly or superiorly based, unilateral or bilateral nasolabial flaps for local extraoral and intraoral reconstruction. Patients were evaluated for postoperative complications, flap uptake, donor site morbidity and postoperative extraoral scarring.

Results

In all cases, postoperative complications were relatively minor except in one flap where total flap loss was encountered. The average time taken for preparation of recipient site, flap elevation and closure was 72 min. The nasolabial flap proved itself to be extremely vascular and thus safe and suitable with satisfactory cosmetic outcomes.

Conclusion

The nasolabial flap proves to be a versatile flap with a proven blood supply from the facial, transverse facial and infraorbital vessels. It establishes itself as a simple procedure to execute to reconstruct the various defects of the anterior orofacial region. It is considered to be a safe flap with a low complication rate, and most importantly it offers a cosmetically pleasing and functionally satisfactory solution.

Evaluation of facial artery perforator-based flaps in reconstruction of facial defects

Introduction

Several flaps have been described for reconstructing facial or oral defects. Flaps such as forehead and pectoralis major are often too bulky for small-to-moderate-sized defects, for which nasolabial flaps are often ideal. However, nasolabial flaps have limited mobility and reach and may need two stages, particularly for intraoral defects. According to recent literatures, facial artery provides numerous small cutaneous perforators, based on which skin flaps can be islanded, with greater mobility and reach for reconstruction of small-to-moderate-sized intraoral and facial defects in one stage. Our study aims to evaluate the reliability and versatility of facial artery perforator-based flaps in the reconstruction of such defects.

Materials and Methods

A ethical committee-approved retrospective study was conducted on data of the patients attending our outpatient department between February 2014 and October 2015 with small-to-moderate-sized facial/oral lesions. The total sample size was 23. We studied the relation of flap survival with size of flap, route of inset and neck dissection, functional and aesthetic outcomes and feasibility of adjuvant therapy in cases of malignancies.

Results and Analysis

A wide range of facial defects, especially intraoral defects, could be reconstructed in one stage using facial artery perforator-based flaps. The flaps were reliable. Complications included only partial skin loss of the flaps in a few cases. Complications were directly related to the length of the flaps and the route of inset. Functional and aesthetic outcomes were satisfactory and none of the flaps showed any significant post-radiotherapy changes.

Conclusions

We concluded that facial artery perforator flap can be a simple, safe, versatile and one-stage alternative to the traditional flaps in the reconstruction of small-to-moderate-sized facial defects. Neck dissection can be safely done in the same sitting.

Inferiorly Pedicled Nasolabial Flap for Reconstruction of Anterior Maxilla Defects Class I and II

OBJECTIVES

The aim of this study was to present the use of inferiorly pedicled nasolabial flap (IPNF) in the reconstruction of anterior maxilla defects class I and II.

METHODS

Seven patients, 4 females and 3 males, aging from 38 to 75 (mean = 55.9) years old, from 2014 to 2017 reconstructed anterior part of maxilla with or without oronasal communication were included in this study. Five patients diagnosed with squamous cell carcinoma, 1 patient presented with epithelial-myoepithelial carcinoma, and 1 patient had ameloblastoma. The IPNFs were harvested in 7 patients. Follow-up data were collected for a period ranging from 9 to 26 months. Speech, mastication, and aesthetic outcomes were evaluated with a questionnaire in interview.

RESULTS

All patients healed without infection, flap loss, and flap failure. Five patients without prothetic treatment had little pronunciation problem (score: 1 to 3 points), while 2 patients with removable partial denture had excellent speech clarity (score: 1 to 2 points). All patients had no problem with mastication (score: 1 to 2 points). Aesthetic outcomes were acceptable in all patients (score: 1 to 3 points).

CONCLUSION

The IPNF is a good option for reconstruction of anterior maxilla defects class I and II.

An unusual complication of nasolabial flap reconstruction

Squamous cell carcinoma is the most common carcinoma in the oral cavity. Resection of these cancers often requires reconstruction. Nasolabial flaps are a robust and reliable local flap that provide a satisfactory outcome. We report two cases where an epidermoid cyst developed within the scar of the nasolabial flap and review the literature.

Nasolabial pedicled compared with island flaps for intraoral reconstruction of oncological defects: complications, recovery of sensitivity, and assessment of quality of life

Our aim was to compare pedicled and island nasolabial flaps used for reconstruction of oral defects in terms of postoperative complications, recovery of sensitivity, and quality of life. We organised a retrospective cohort study of 49 patients who had had intraoral reconstruction with nasolabial pedicled (n-=13) and island (n=36) flaps. Twenty- two patients filled in a validated quality-of-life (QoL) questionnaire and we did sensitivity tests (sharp discrimination with the aid of a Semmes-Weinstein™ aesthesiometer). Descriptive and bivariate statistics were computed and probabilities of 0.05 were accepted as significant. There were 11 flap-related complications (22%), and the flap was totally necrotic in three patients (6%), all of whom had island flaps. There was a significant association between flap-related complications and the use of reconstruction plate p=0.001, 95% CI 2.36 to 11.37) and advanced stage (T3 and T4 p=0.01, 95% CI 1.45 to 5.26). Skin sensitivity recovered in both island and pedicled flaps. Patients treated with island flaps had significantly more problems with prosthetic rehabilitation than those treated with pedicled flaps. The relatively low morbidity and adequate functional and aesthetic results make the pedicled nasolabial flap a viable technique. De-epithelialisation of the pedicle in island flaps permits coverage of defects with unilateral flaps in a one-stage reconstruction. However, the pedicle may be excessively stretched, leading to ischaemic complications.

Reconstruction of Tongue Defects With the Contralateral Nasolabial Island Flap

PURPOSE

Reconstruction of tongue defects after cancer resection is challenging for reconstructive surgeons. Conventional local flaps are usually compromised in patients with suspected ipsilateral neck metastasis. To extend the application of the nasolabial flap, especially in circumstances in which a free flap is unavailable, the contralateral nasolabial island flap was used, with favorable outcomes.

PATIENTS AND METHODS

Seven patients presenting with tongue carcinoma underwent surgical resection and neck dissection. Tongue defects were simultaneously reconstructed using a contralateral nasolabial island flap. Clinical outcomes, including locoregional recurrence and distant metastasis, were recorded. Subjective functional outcomes were investigated using the University of Washington Quality of Life Questionnaire.

RESULTS

All flaps survived without partial or complete necrosis. All patients survived without locoregional recurrence or distant metastasis during follow-up (6 months to 2 years). Functional outcomes were satisfactory, especially swallowing and speech functions. Donor-site morbidity was minimal and the scars were inconspicuously hidden in the nasolabial fold.

CONCLUSIONS

The contralateral nasolabial island flap is technically feasible and can be an excellent option for tongue reconstruction without compromising oncologic safety.

Efficacy of nasolabial flap in reconstruction of fibrotomy defect in surgical management of oral submucous fibrosis: a prospective study

PURPOSE

Various surgical modalities have been used in the surgical management of oral submucous fibrosis with variable results. This prospective study evaluates the efficacy of nasolabial flap in the reconstruction of fibrotomy defect in surgical treatment of oral submucous fibrosis in terms of functional and esthetic outcomes.

MATERIAL AND METHOD

In this prospective study, we treated 20 patients of oral submucous fibrosis surgically. The surgical protocol was consisting of bilateral fibrotomy, temporal myotomy, and coronoidotomy or coronoidectomy followed by reconstruction of fibrotomy defect with bilateral extended nasolabial flaps. All patients were prescribed with nutritional supplements and antioxidants. Vigorous mouth opening exercise was made compulsory for every patient. Preoperative and postoperative evaluation was done for interincisal mouth opening, function of mastication, and cosmetic results. Patient's regular follow-up was done for 2 years.

RESULTS

Postoperatively, we noted excellent increase in the interincisal mouth opening relieving trismus. Patient's ability to chew solid food was increased significantly. Extraoral scar was minimal and well accepted by all the patients. There was no morbidity of the donor site. There was no injury to the facial nerve in all cases. The only drawback was intraoral hair growth which went on reducing with mucosalization of the graft tissue.

CONCLUSION

Random pattern nasolabial flap is a very good option for intraoral reconstruction of fibrotomy defect in surgical treatment of oral submucous fibrosis with excellent functional and cosmetic results with minimal complications.

Maxillofacial reconstruction with nasolabial and facial artery musculomucosal flaps

The nasolabial and facial artery musculomucosal (FAMM) flaps are predictable methods to reconstruct perioral and intraoral defects with vascularized tissue. The nasolabial flap can be harvested as an axial or random patterned flap, whereas the FAMM flap is truly an axial patterned flap, with either a superior or an inferior base. Both flaps have been widely used to provide predictable results, with low morbidity. Future studies are needed to further prove their use in compromised patients, including patients with a history of head and neck radiation and neck dissections.

Head and neck cancer patients' perceptions of quality of life and how it is affected by the disease and enteral tube feeding during treatment

AIM

To explore individual quality of life in patients with head and neck cancer from diagnosis up to 3 months after termination of radiotherapy.

RESEARCH QUESTIONS

1) Which areas in life are important to quality of life, and which are influenced by the disease and by having oral or enteral nutrition; and 2) Which areas in life are influenced by having a nasogastric feeding tube (NGT) or a percutaneous endoscopic gastrostomy (PEG) tube?

MATERIAL AND METHODS

Data were collected in 36 patients. Semi-structured interviews were conducted using an extended version of the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) and analysed with content analysis.

RESULTS

Negative and positive experiences of quality of life in general were about relation to family, own health, and leisure activities. Negative impacts on physical, psychological, existential and social problems, but also positive experiences are described by the patients related to the disease. More than half expressed eating-related problems. Enteral nutrition entailed negative and positive experiences, and no greater variations were described by the patients with NGT or PEG tube. Overall, there were interindividual variations.

CONCLUSIONS

The patients' perception of general or disease-related quality of life was not affected by whether they had enteral nutrition or not. From the patients' perspective neither of the two feeding tubes (NGT or PEG) was clearly in favour. We suggest that more studies are needed on how the choice of enteral feeding tube can be evidence-based, and incorporating the patients' perspective.

The nasolabial flap as a one-stage procedure for reconstruction of intermediate-to-large lip defects with functional and aesthetic assessments

OBJECTIVES

The primary function of the lip is oral competence. The lips are also fundamental in facial aesthetics. Thus in lip reconstruction, it is paramount to achieve both good functional and aesthetic outcomes. Local flaps are able to provide the best tissue match in intermediate and large lip defects. Nevertheless, there has been limited literature on using the musculocutaneous nasolabial flap as a one-stage procedure for lip reconstruction.

METHODS

The authors recruited 21 patients who underwent a one-stage nasolabial musculocutaneous flap reconstruction for lip defects for the study. The modiolus at the mouth angle was preserved and the nasolabial flap was de-epithelised and tunnelled subcutaneously in all patients for reconstructing the lips. Electromyography was performed for 14 flaps to detect muscle activity. Oral competency was assessed using the Drooling Rating Scale and aesthetic outcomes were also analysed postoperatively with the Patient and Observer Scar Assessment Scale.

RESULTS

All patients successfully underwent lip reconstruction with the musculocutaneous nasolabial flap. There were no flap failures. Electromyographic activity was detected in 10 out of the 14 flaps tested. Oral competencies were well preserved and there were no cases of microstomia. Aesthetic results were also good.

CONCLUSION

The nasolabial flap for one-stage reconstruction of lip defects following lip resection is feasible. Good functional and aesthetic outcome can be achieved.

The Use of a Nasolabial Island Flap in Vestibulo-sulcoplasty in a Patient with Recurrent Depressed Scar on the Modiolus

A 56-year-old woman with a recurrent depressed scar of the commissure, treated with a nasolabial island flap, is presented. On examination, the scar was located on the right modiolus involving the right upper gingivobuccal sulcus. A history of recurrent canine abscess was obtained. After excision of the scar and release of the vestibular fold, reconstruction of the defect was performed with a nasolabial island flap from the same side. The postoperative course was uneventful, with a good aesthetic and functional outcome.

One stage reconstruction of the floor of the mouth with a subcutaneous pedicled nasolabial flap

BACKGROUND

Nasolabial flaps have been recognised as versatile flaps for a variety of defects in the face, nose, lip and the oral cavity. Random pattern inferiorly based nasolabial flaps (NLF) have been utilised for covering small defects on the anterior floor of the mouth, but usually require a second stage procedure to divide the flap base. A subcutaneous pedicled inferiorly based nasolabial flap can provide a one stage repair of moderate sized defects of the floor of the mouth after de epithelialisation of the base of the flap.

AIM

To evaluate the feasibility of a single stage reconstruction of intermediate sized defects in the oral cavity with an inferiorly based pedicled NLF. The study includes the indications of use of the flap, flap design, technique, and the complications rate. The incidence of secondary procedures and the final functional and the aesthetic results will also be evaluated.

MATERIALS AND METHODS

A group of 20 patients presented with (T1-2) squamous cell carcinoma of the oral cavity have been treated at the Department of Surgery, National Cancer Institute, Cairo; in the period between January 2008 and September 2010. The pathology was confirmed with an incision biopsy and all metastatic work were carried out confirming that all patients were free from distant metastasis at presentation. Preoperative assessment also included assessment of the stage of the disease, the flap design and patient fitness for general anaesthesia. All patients underwent surgical excision combined with reconstruction of the defect with a subcutaneous inferiorly based pedicled NLF. The proximal part of the flap was routinely de epithelialised before it has been tunnelled through the cheek so a one stage procedure could only be required.

RESULTS

The mean age of the patients was 62.3±6years, range (52-69years). All patients were diagnosed with squamous cell carcinoma. The anterior floor of the mouth constituted 40% of the defects, the lateral floor of the mouth 20% and the inner surface of the cheek 40%. There was no reported major complication; and only one patient suffered a reactionary haemorrhage that required re-exploration to secure the bleeder. A single procedure was adequate in most patients (80%), only 20% of patients required revision of the scar at the donor site or release of the tongue. The overall aesthetic results were either very satisfactory or satisfactory in the majority of patients (90%). Two patients were not satisfied with the final aesthetic results, one suffered from ectropion and the other had a donor site wound healing problem. The functional results (deglutition, speech) were satisfactory in most patients (70%), all were edentulous.

CONCLUSION

An inferiorly based pedicled NLF is a reliable flap for the reconstruction of small and medium sized defects in the oral cavity. The flap can be best utilised for old edentulous and high risk patients where it can be used as a single stage procedure which is particularly useful in those types of patients. The flap can be safely combined with neck dissection even when the facial artery was ligated.

Use of nasolabial flap in intra and extraoral reconstruction: our experience with 40 cases

PURPOSE

This article represents the use of inferiorly based nasolabial flap in reconstruction of various intraoral and extraoral defects.

PATIENTS AND METHODS

Nasolabial flaps were performed in 40 patients, for reconstruction of buccal mucosa, gingivobuccal sulcus, commissure, lower lip, floor of mouth, upper lip and lower alveolar defects.

RESULTS

The most common defect site in the oral cavity was the buccal mucosa. Partial flap necrosis occurred in five patients. Out of 40 cases of carcinoma of lip, commissure and floor of the mouth, all the patients had good speech after complete healing of the wound. None of the patients who had lip or commissure reconstruction developed drooling of saliva due to lip incompetence.

CONCLUSION

The inferiorly based nasolabial flap provides reliable coverage of intermediate-sized oral cavity defects when used alone. Minimal donor morbidity is associated with its use. It is especially useful in elderly patients with facial skin laxity and where esthetics is not a major concern.

Reconstruction of oral mucosal defects using the nasolabial flap: clinical experience with 22 patients

BACKGROUND

Various surgical options are available for reconstruction of intraoral soft tissue defects. For smaller defects of the oral mucosa in different anatomic locations of the oral cavity the nasolabial flap is a very useful and simple alternative to other pedicled flaps and free flaps.

METHODS

The results of reconstruction of oral mucosal defects or facial skin defects using 29 nasolabial flaps in 22 patients were reviewed retrospectively.

RESULTS

The patient group consisted of 16 patients (70%) with squamous cell carcinoma of the oral cavity, 2 patients (10%) with cystic lesions of the maxilla, 3 patients (15%) with osteonecrosis of the jaw, and 1 patient with an oral metastasis of a lung carcinoma. Healing was uneventful in 93%, partial or complete flap loss was observed in 7%.

CONCLUSIONS

The nasolabial flap is a valuable alternative for reconstruction of smaller defects of the oral cavity in particular in older and medically compromised patients.

[Applicable methods of reconstruction for the replacement of soft tissue after the radical resection of oral tumors]

In Hungary the number of oral and pharyngeal cancers is alarmingly high. While the mortality rate in 1955 was 282, by 2005 it rose to 1567. However, in the last 1-2 years stagnation can be observed. Nevertheless, even now significant proportions of men and women are involved. Alcohol consumption and smoking are invariably the leading causes, but one cannot disregard the shortcomings of oral cancer screenings, either. Unfortunately, drastic changes in this field are not likely to occur in the near future. Numerous solutions have been developed for the replacement of soft tissue. In our article, we describe and evaluate four of them. When using these techniques, we were often successful in replacing soft tissue deficiencies.

[Reconstruction of the alae nasi by folded nasolabial flap]

Reconstruction of the nose is very old surgical procedure and, in fact, represents the beginnings of plastic surgery. In reconstruction, an effort has to be made in order to achieve a normal look. A surgeon must choose carefully the method of reconstruction, taking into consideration the skin color, texture and nasal topography. Full-thickness nasal defects in alar region are very difficult for reconstruction due to anatomic characteristics and structures, which are very important for normal breathing and cosmetic result. Our study analyzed 16 patients with full-thickness defect of alae nasi. Folded nasolabial flaps were used for reconstruction of these defects. Good results were achieved in all cases. The flap was vital. No flap necrosis was reported in any of these patients. The lining of the nose was good. Postoperatively, the alar edge was thickened, but it became thinned after six months. The incision in donor's region was well placed in the natural line of nasolabial fold. It was concluded that folded nasolabial flap was extremely good one-step procedure for reconstruction of full-thickness defects of alar region.

Functional and Aesthetic Outcome and Survival after Double Free Flap Reconstruction in Advanced Head and Neck Cancer Patients

BACKGROUND

Extensive composite defects in the head and neck area may require the use of double free flap reconstructions. These reconstructions are not only surgically challenging but also challenging to patients. A realistic perspective on general outcome for the patient seems important.

METHODS

From January of 2002 to August of 2003, double free flap reconstructions were used in 12 patients with extensive composite head and neck defects following malignant tumor (n = 7) and osteoradionecrosis (n = 5) resection. Six patients had a standardized interview, physical examination, and clinical photographs.

RESULTS

All reconstructions were performed using an osteocutaneous fibula flap in combination with an anterolateral thigh flap (n = 8), a radial forearm flap (n = 1), or a lateral thigh flap (n = 1). The total flap survival rate was 96 percent. Mean mandibular bone defects were 10 cm. Mean skin island sizes of osteocutaneous fibula flaps were 67 cm. Mean external skin reconstruction flap sizes were 117 cm. Mean overall survival time was 20 months in patients with malignant tumors. Patients with osteoradionecrosis reconstruction survived free of disease for an average period of 38 months. Three patients (50 percent) were very satisfied, one was neutral, and two were very dissatisfied with their functional and aesthetic results. Objective evaluation of function showed mainly deteriorated speech (83 percent) and oral incontinence (67 percent). Objective evaluation of aesthetics showed mainly color mismatch (67 percent) and flap contracture of external flaps (50 percent).

CONCLUSIONS

Reconstruction of these major composite through-and-through defects will often result in a modest functional and aesthetic outcome. Because selected patients require these procedures, the authors give information that matches with realistic expectations.

Long-term functional outcome and satisfaction after radial forearm free flap reconstructions of intraoral malignancy resections

PURPOSE

Evaluation of objective and subjective functional follow-up results of intraoral radial forearm free flap reconstructions.

METHODS

A total of 149 patients had received radial forearm free flaps between January 1996 and December 2005. Seventy-two patients completed a European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35 (EORTC H&N35) in the follow-up study. Patients were divided according to location of defect (anterior or posterior) or irradiation. Thirty-nine patients with anterior positioned flaps received standardised physical examinations.

RESULTS

Flap survival was 99.3%. Complications were divided in early (<2 weeks; 23%) and late complications (20%). Most common complications were dehiscence or fistula, responding well to conservative treatment. Analysis of questionnaire subscales showed no statistically significant differences between anterior and posterior defects. Irradiation showed significant impairment for the ability to smell and taste. No important donor site impairment was found.

CONCLUSION

The radial forearm free flap is an adequate method for reconstructions after resection of intraoral malignancies. Subjective functional outcome seemed to be defined by adjuvant radiotherapy, patient coping and, to a lesser extent, flap bulk for anterior defects.

Corrosive injury of oral cavity – a rare presentation

Corrosive injury of the upper gastrointestinal tract has been frequently reported in medical literature. The ingestion of acid or alkali may be accidental or intentional. The spectrum of injury varies from involving the oesophagus, stomach, and duodenum either individually or together. The oral cavity is rarely involved. The sequelae of oral cavity caustic injury that have been reported include microstomia, shallow vestibule, ankyloglossia, speech impairment, loss of teeth and impairment of facial expression. We report a case of corrosive injury of the oral cavity following accidental ingestion of caustic alkali, who presented to us with bilateral submandibular gland enlargement following the development of corrosive stricture of the submandibular ducts. The scar tissue in the anterior floor mouth was excised with the submandibular salivary glands. Concomitant release of the contracture in the gingivo-buccal sulcus was also done and the defect was covered with a radial forearm free flap. The presentation of corrosive oral injury as salivary duct obstruction and enlarged salivary glands has not been reported. Free tissue transfer for corrosive scarring in the oral cavity helps to restore pliable tissue.