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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.
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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
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Ki SH, Park TJ. Prevention and treatment of microstomia. Arch Craniofac Surg 2024; 25:105-115. [PMID: 38977395 PMCID: PMC11231408 DOI: 10.7181/acfs.2024.00276] [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: 05/19/2024] [Revised: 05/19/2024] [Accepted: 06/11/2024] [Indexed: 07/10/2024] Open
Abstract
The mouth, located in the lower third of the face, is a uniquely visible structure. It serves as a vital organ both aesthetically and functionally, playing a key role in speech, expression, and fundamental oral functions. Consequently, any alterations or defects in its shape, due to various causes, can lead to aesthetic and functional deficiencies. These issues may also result in challenges with social interactions and a decrease in confidence. In cases of microstomia, various surgical approaches are proposed based on the location, extent, shape, and cause of the defect, leading to numerous case reports. Plastic surgeons are proficient in oral reconstruction; however, cases of microstomia are relatively rare, which reduces their familiarity and interest in these cases. Additionally, preferences for oral size and shape vary according to factors such as geographical region and ethnicity, further complicating the functional definition of microstomia. Therefore, both subjective patient and physician judgments play crucial roles in the diagnosis and treatment of microstomia, as these may vary depending on individual and societal aspects. This review aims to classify the various causes and definitions of microstomia, as well as its non-surgical and surgical treatment options, with the goal of the treatment of this condition.
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Affiliation(s)
- Sae Hwi Ki
- Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, Korea
- Department of Plastic and Reconstructive Surgery, Inha University School of Medicine, Incheon, Korea
| | - Tae Jun Park
- Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, Korea
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Srivanitchapoom C, Yata K. Medium-sized buccal mucosa defect reconstruction with buccal advancement flap in mucoepidermoid carcinoma ex pleomorphic adenoma: a case report. Ann Med Surg (Lond) 2024; 86:525-529. [PMID: 38222703 PMCID: PMC10783379 DOI: 10.1097/ms9.0000000000001514] [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: 09/19/2023] [Accepted: 11/05/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction and importance Mucoepidermoid carcinoma (MEC) ex pleomorphic adenoma is a rare type of salivary gland cancer. Surgical resection remains the standard therapy for this malignancy. After tumor removal, larger defects may require a local, regional, or free flap, while smaller ones can be closed primarily. Managing medium-sized defects can be challenging, especially on the buccal mucosa. Presentation of case A 47-year-old man had a buccal mucosa mass for 10 years, which gradually grew over a year and irritated his chewing. A 2.2×2 cm buccal mass was observed with telangiectatic and erythematous alterations in the surrounding mucosa. The preoperative tissue biopsy suggested salivary gland malignancy. The patient underwent surgical excision and a single-stage buccal advancement flap reconstruction, successfully closing the 4 cm defect. The final diagnosis was MEC ex pleomorphic adenoma. He reported mild discomfort during the first few months while opening his mouth. The patient had fully recovered after 6 months. Clinical discussion This is the first case of MEC arising in a pleomorphic adenoma of the buccal mucosa. For low-grade and small-sized tumors, a single modality is appropriate for treatment. Local flaps such as buccal fat pad or musculomucosal flap can repair medium-sized defects. However, the buccal advancement flap provides effective functional and esthetic benefits, optimal healing conditions, and reduces complications risk. Conclusion The buccal advancement flap is a valuable option for reconstructing medium-sized buccal defects up to 4 cm. The single-stage surgical procedure has been proven to yield minimal complications and provide a favorable outcome.
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Cho W, Jang EA, Kim KN. Single-Stage Peninsular-Shaped Lateral Tongue Flap for Personalized Reconstruction of Various Small- to Moderate-Sized Intraoral Defects: A Retrospective Case Series with Tongue Function Evaluation Using the Functional Intraoral Glasgow Scale. J Pers Med 2023; 13:1637. [PMID: 38138864 PMCID: PMC10744366 DOI: 10.3390/jpm13121637] [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: 10/27/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Herein, we present our experience using a single-stage peninsular-shaped lateral tongue flap (pLTF) to cover various intraoral defects and confirm the versatile utility and effective application of pLTF in intraoral defect reconstruction. This study included eight cases (six males and two females; average age 60.3 ± 16.9 years) of intraoral defect reconstruction performed by a single surgeon between August 2020 and May 2023 using the single-stage pLTF technique. Electronic medical records and photographs of the patients were collected and analyzed. The functional intraoral Glasgow scale (FIGS) was used to evaluate preoperative and postoperative tongue function. Defect sizes ranged from 3 cm × 3 cm to 4 cm × 6 cm. Notably, all defects were successfully covered with pLTFs, and the flap sizes ranged between 3 cm × 4.5 cm and 4.5 cm × 7.5 cm. The flaps completely survived without any postoperative complications. At follow-up (average, 9.87 ± 2.74 months), no patient had tumor recurrence or significant tongue functional deficits. The mean preoperative and postoperative FIGS were 14.75 ± 0.46 and 14.00 ± 0.92, respectively (p = 0.059). Thus, the single-stage pLTF technique is a good reconstructive modality for various small to moderate intraoral defect coverage in selected cases for personalized intraoral reconstruction.
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Affiliation(s)
| | | | - Kyu-Nam Kim
- Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul 03181, Republic of Korea; (W.C.); (E.-A.J.)
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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Ma C, Sheng S, Gao W, Haugen T, Zhu Y, Shen Y. Clinical comparison of superior thyroid artery perforator flap and sternocleidomastoid myocutaneous flap for intraoral reconstruction. Int J Oral Maxillofac Surg 2023; 52:318-327. [PMID: 35835682 DOI: 10.1016/j.ijom.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 06/02/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
The aim was to evaluate the techniques and outcomes of superior thyroid artery perforator flaps (STAPF) for intraoral reconstruction and to compare them with those of the sternocleidomastoid myocutaneous flap (SCMMF). The cases of 43 patients who underwent reconstruction with either a SCMMF or STAPF for the repair of a medium-sized intraoral defect, between January 2013 and December 2020, were reviewed retrospectively. Although both flaps are based on the superior thyroid artery, their specific harvesting techniques largely differ. All SCMMF (n = 23) were superiorly-based rotational flaps with myocutaneous designs. The STAPF cases (n = 20) included 18 septocutaneous flaps and two chimeric flaps. The flap size was larger in the STAPF group (P = 0.008), while incomplete level IIB dissection (oncological safety) was more frequent in the SCMMF group (P = 0.002). The flap necrosis rate was lower in the STAPF group (STAPF 15% vs SCMMF 34.8%, though this was not statistically significant). Cox multivariate analysis showed that the postoperative flap outcome (total flap necrosis vs flap survival; hazard ratio 27, 95% confidence interval 2.149-336.05; P = 0.001) and complications (excluding fistula) (hazard ratio 14, 95% confidence interval 1.314-142.767; P = 0.029) were associated with overall patient survival. Both speech (P < 0.001) and neck mobility (P < 0.001) functions were superior with STAPF reconstruction. Compared with the traditional SCMMF, the STAPF was found to have a lower necrosis rate with uncompromised oncological safety during harvesting. The STAPF is a good alternative for the repair of medium-sized head and neck defects.
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Affiliation(s)
- C Ma
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - S Sheng
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - W Gao
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - T Haugen
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Y Zhu
- Department of CT Clinical Research, CT Business Unit, Canon Medical Systems (China) Co., Ltd, Beijing, China
| | - Y Shen
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
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McIlwain W, Inman J, Namin A, Kazi A, Shumrick C, Ducic Y. Management of Palatal Defects after Free-Flap Reconstruction and Radiotherapy. Semin Plast Surg 2023; 37:39-45. [PMID: 36776801 PMCID: PMC9911226 DOI: 10.1055/s-0042-1759797] [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: 12/24/2022]
Abstract
Palatal fistulas have significant effects on quality of life. Traditional prosthetic rehabilitation and surgical reconstruction of palate defects in radiation-naïve tissues are well described. However, palatal fistulas developing after initial tumor extirpation, free-flap reconstruction, and adjuvant radiation or chemoradiation are associated with challenging secondary tissue effects. In this review, we will discuss the management of palatal fistulas after surgical reconstruction and radiotherapy.
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Affiliation(s)
- Wesley McIlwain
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Jared Inman
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Arya Namin
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Aasif Kazi
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Christopher Shumrick
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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The Role of Full-Thickness Skin Grafts in Patient’s Rehabilitation after Maxillectomy and Midface Defects. J Clin Med 2022; 11:jcm11133608. [PMID: 35806898 PMCID: PMC9267337 DOI: 10.3390/jcm11133608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Nowadays, microvascular grafts are the gold standard in the reconstruction of midface defects after maxillectomy, however, not all patients may qualify for this type of surgery. The purpose of present study is to evaluate the benefits of alternative reconstruction methods such as full-thickness skin grafts for these conditions. (2) Methods: The research group consisted of 37 patients who underwent maxillectomy due to cancer of the mid-face and had full-thickness skin graft reconstruction. The study covered the period from 2011 to 2020. (3) Results: Based on the clinical examination and the subjective assessment of patients, a positive effect of the use of free skin grafts on their convalescence and rehabilitation was found. In particular, they contributed to the reduction in postoperative pain and pain associated with prosthetic stages (VAS Scale). (4) Conclusion: Full-thickness skin grafts in combination with individual prosthetic restorations are a good alternative to rehabilitation in patients who do not qualify for microsurgical treatment.
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Alfonso A, Parra Carreño A, Beltrán PP. Functional and Aesthetic Lower Lip Reconstruction Using the Yotsuyanagy Flap. Ann Plast Surg 2022; 88:282-287. [PMID: 34670967 DOI: 10.1097/sap.0000000000002976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Lower lip defects are a major challenge from a reconstructive perspective. The lower lip is an anatomical region formed by different types of tissue, and it is essential to obtain adequate functional and aesthetic results. When local tissue is available to be a donor area, it becomes the best option to repair the defect. This article's purpose is to present our experience in reconstruction of partial or transfixing total defects of the lower lip with the musculocutaneous flap of the depressor anguli oris described by Yotsuyanagi.
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Affiliation(s)
- Amanda Alfonso
- From the Department of Plastic Surgery, Centro de Investigaciones Oncológicas Clínica San Diego/CIOSAD-Instituto Nacional de Cancerología
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Soft Palate Fistula in a Patient With Normal Palate as a Rare Complication After Septoplasty. J Craniofac Surg 2021; 32:1775-1776. [PMID: 33427775 DOI: 10.1097/scs.0000000000007415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT While the formation of a palatal fistula after septoplasty has been reported previously, it is a rare occurrence, especially in a patient with a normal palate. In most of the previous reports, the palatal fistulas were located on the hard palate and associated with various underlying conditions. Here, we present a case of soft palate fistula which developed in a patient with a normal palate after septoplasty. The 20-year old woman complained of liquid regurgitation after her septoplasty procedure. A pin-point size fistula opening was observed on the soft palate. A shallow depression was identified at the junction between the hard and soft palate by a computed tomography scan done before surgery. The fistula was subsequently repaired through a palatal flap. After surgery, the defect was completely closed, and the patient had no more symptoms. In addition, we review the previously reported cases of palatal fistula after septoplasty.
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Abstract
PURPOSE OF REVIEW The strain on healthcare resources in light of the COVID-19 pandemic has forced many head and neck surgeons to explore reconstructive options that may decrease length of stay. Here, we review three common and versatile regional flaps used in head and neck reconstruction that are comparable alternatives to free tissue transfer. RECENT FINDINGS Initial anatomic descriptions of the facial artery musculocutaneous (FAMM) flap, the supraclavicular artery island flap and the submental artery island flap were published decades ago. Since then, many have proposed modifications to these descriptions to improve technical ease and patient outcomes. Benefits of regional flaps include ease of harvest, comparable outcomes to free tissue microvascular flaps, shorter operative time and hospital length of stay. Drawbacks to regional flaps include limitations to size and reach, partial necrosis, wound dehiscence and surgeon experience. The integrity of the vascular pedicle is also contingent upon vessel preservation during the cancer ablation. SUMMARY Although a resurgence of regional flaps began well before the COVID-19 pandemic, many institutions began looking for alternatives to free flap reconstruction to conserve healthcare resources and minimize patient hospitalization time in the past year. There has been a revival of regional flaps such as the FAMM, supraclavicular and submental flaps that are valuable reconstructive options for many defects of the head and neck.
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Guzu M, Rossetti D, Hennet PR. Locoregional Flap Reconstruction Following Oromaxillofacial Oncologic Surgery in Dogs and Cats: A Review and Decisional Algorithm. Front Vet Sci 2021; 8:685036. [PMID: 34095284 PMCID: PMC8175653 DOI: 10.3389/fvets.2021.685036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
Primary treatment of most oromaxillofacial tumors in dogs and cats is resective surgery. Management of malignant tumors may be very challenging as wide/radical free-margin surgical removal must be achieved while preserving vital functions. Removal of orofacial tumors may result in large defects exposing the oral cavity or creating a communication with the nasal, pharyngeal, or orbital cavities. Such defects require orofacial reconstruction in order to restore respiratory and manducatory functions. The veterinary surgeon must be familiar with reconstructive techniques in order to prevent the inability of closing the defect, which could lead to an insufficient resection. Small oral defects exposing the nasal cavity are best closed with local random mucosal flaps. Closure of large oral defects may be better achieved with a facial or major palatine-based axial-pattern flap. Small to moderate facial defects can be closed with local advancement or transposition skin flaps. Reconstruction of large facial defects often requires the use of locoregional axial pattern flaps such as the caudal auricular, the superficial temporal, or the facial (angularis oris) myocutaneous axial pattern flaps. Recent publications have shown that the facial (angularis oris) flap is a very versatile and reliable flap in orofacial reconstructive surgery. A surgical decision algorithm based on the size, nature, and location of the defect is proposed.
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Affiliation(s)
- Michel Guzu
- Dentistry and Oromaxillofacial Surgery Unit, Department of Surgery, ADVETIA Centre Hospitalier Vétérinaire, Vélizy-Villacoublay, France
| | - Diego Rossetti
- Department of Surgery, CHV ADVETIA, Vélizy-Villacoublay, France
| | - Philippe R. Hennet
- Dentistry and Oromaxillofacial Surgery Unit, Department of Surgery, ADVETIA Centre Hospitalier Vétérinaire, Vélizy-Villacoublay, France
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Malinge M, Piot B, Longis J, Nham TT, Anquetil M, Bertin H. The sublingual gland flap: surgical technique and indications for the reconstruction of small oral defects. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2021. [DOI: 10.1051/mbcb/2021004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Colella G, Rauso R, De Cicco D, Boschetti CE, Iorio B, Spuntarelli C, Franco R, Tartaro G. Clinical management of squamous cell carcinoma of the tongue: patients not eligible for free flaps, a systematic review of the literature. Expert Rev Anticancer Ther 2020; 21:9-22. [PMID: 33081545 DOI: 10.1080/14737140.2021.1840359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The management of squamous cell carcinoma (SCC) of the tongue represents the most demanding treatment planning in head and neck surgery. Ablation followed by free flap reconstruction is considered the gold standard, but not all patients are suitable for this strategy. The aim of this review is to provide a comprehensive view of surgical reconstruction possibilities in patients not eligible for free flaps. METHODS Following PRISMA recommendations, a systematic literature review was conducted searching for original papers that investigated outcomes of patients treated by surgical ablation for tongue SCC followed by reconstruction with local or pedicled flaps. Selected papers were read and data extracted for qualitative analysis. RESULTS Twenty articles met the inclusion/exclusion criteria. The study design was case series in sixteen papers, cohort study in the remaining four. Four different local flaps (BMM, FAMM, NLIF, SMIF) and four regional flaps have been discussed in included studies (IHF, SFIF, SCM, PMMC). CONCLUSION The improved anatomical knowledge makes local flaps a reliable alternative to free tissue transfer in cases requiring small-/medium-sized defects. Regional flaps still represent cornerstones in reconstruction of the tongue. Ease of execution, costs-to-benefit ratio, low-rate complications, minimal donor site morbidity represent the best advantages choosing local/regional flaps.
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Affiliation(s)
- Giuseppe Colella
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Raffaele Rauso
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Davide De Cicco
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II" , Naples, Italy
| | - Ciro Emiliano Boschetti
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II" , Naples, Italy
| | - Brigida Iorio
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II" , Naples, Italy
| | - Chiara Spuntarelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II" , Naples, Italy
| | - Renato Franco
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Gianpaolo Tartaro
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" , Naples, Italy
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Mannelli G, Agostini T, Arcuri F, Comini LV, Spinelli G. Subclavicular flap: A valid reconstructive option among anterior chest flaps in oral cancer patients. J Surg Oncol 2019; 120:707-714. [PMID: 31364178 DOI: 10.1002/jso.25655] [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: 02/18/2019] [Accepted: 07/23/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The subclavicular pedicled flap is based on the thoracic branch of the supraclavicular artery, and it represents a versatile reconstructive option for low-middle third face defects. Since its use in head and neck surgical oncology has not been popularized yet, we propose its application for oral cavity reconstruction after cancer resection by showing favorable results. METHODS Eighteen subclavicular pedicled flaps were used to treat intraoral defects after oral squamous-cell cancer resection between June 2015 and December 2018. Tumor dissection type, complications, donor and reconstructed area results, and functional and aesthetic outcomes were assessed. RESULTS No major complications were observed and all of the flaps survived. Adjuvant therapy was administered without delay when needed, and all of the patients had normal functional outcomes and good aesthetic results. CONCLUSIONS The subclavicular flap is an excellent choice for the reconstruction of oral cavity defects. Selection of patients should exclude positive lower-third neck node and include appropriate informed consent for women due to the possibility of deformity of the breast. In our opinion, this flap has the potential for common application given its consistent anatomy and donor site advantages, including long pedicle, high pivot point, and relatively unlimited flap width.
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Affiliation(s)
- Giuditta Mannelli
- Head and Neck Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tommaso Agostini
- Department of Plastic and Reconstructive Surgery, Casa di Cura San Paolo, Pistoia, Italy
| | - Francesco Arcuri
- Department of Maxillo Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lara Valentina Comini
- Head and Neck Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Spinelli
- Department of Maxillo Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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