1
|
Calabrese L, Fazio E, Bassani S, Abousiam M, Dallari V, Albi C, Nucera G, Nebiaj A, Zanghi F, Accorona R, Gazzini L. Systematic review of minimally-invasive reconstructive options for oral cavity defects. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:S42-S57. [PMID: 38745516 PMCID: PMC11098536 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/20/2024] [Indexed: 05/16/2024]
Abstract
The oral cavity is a primary site for malignant neoplasms of the head and neck region. Surgery, with or without adjuvant therapy, offers the highest probability of cure by focusing on radical tumour removal and organ function restoration. Reconstructive options are represented by local and free flaps, while small defects can be managed without reconstruction. For medium-sized defects without bone involvement, local flaps can be a good alternative to free flaps in selected patients. The purposes of this article are to analyse the main minimally-invasive reconstructive techniques in oral cancer surgery through a systematic review of the literature and develop a reconstructive algorithm based on the site and size of the defect. We defined minimally-invasive reconstruction as any reconstructive option not involving flap dissection from the neck or other distant areas from the oral cavity. Options considered include: local myo-mucosal or mucosal flaps (based on the facial or buccal arteries, and palatal flap), Bichat’s fat pad flap, and nasolabial flap. Use of biological or synthetic materials is also described. In selected patients with small to moderate-sized defects, the possibility of reconstruction with local flaps can be a viable option.
Collapse
Affiliation(s)
- Luca Calabrese
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Enrico Fazio
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Sara Bassani
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Monir Abousiam
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Virginia Dallari
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Cecilia Albi
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Giuseppe Nucera
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Aurel Nebiaj
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Francesca Zanghi
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Remo Accorona
- Department of Otolaryngology-Head and Neck Surgery, Niguarda Hospital, Milan, Italy
| | - Luca Gazzini
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| |
Collapse
|
2
|
Liu MD, Liu DZ, Al-Aroomi MA, Xiong JJ, Liu S, Sun CF, Liu FY. Reconstruction of large defects of anterior floor of mouth with free flaps using a novel individualized flap design method. J Craniomaxillofac Surg 2023; 51:574-579. [PMID: 37604768 DOI: 10.1016/j.jcms.2023.08.006] [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: 01/27/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
The purpose of this study was to introduce a novel individualized flap design method for large anterior floor of the mouth (AFOM) defect reconstruction, review experience with the use of this flap design method for large AFOM defect reconstruction, and assess its functional results. A retrospective study of patients who received large AFOM defect reconstruction with free flaps was conducted. There was a cohort of patients who were treated using the novel individualized flap design method and a cohort without flap design. Functional outcomes were evaluated with appropriate scales. Outcomes were analyzed, and a p-value <0.05 was considered significant. 22 patients received the individualized flap design, while 21 patients were treated without a special flap design. All flaps survived. All free flaps harvested with the novel individualized flap design method better matched AFOM defects. Relative to patients without flap design, patients in the novel individualized flap design group showed significant improvement in speech intelligibility (p = 0.036) and swallowing function (p = 0.019). Within the limitation of the study it seems that large AFOM defect reconstruction with the novel individualized flap design method can not only cover and close the wound to avoid oral-neck fistulae, but also maintains tongue mobility to achieve better functional outcomes than in patients without flap design.
Collapse
Affiliation(s)
- Min-Da Liu
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, 110002, PR China.
| | - Ding-Zhuo Liu
- Department of Orthopaedics, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R.China
| | - Maged Ali Al-Aroomi
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, 110002, PR China
| | - Jian-Jun Xiong
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, 110002, PR China
| | - Sheng Liu
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, 110002, PR China
| | - Chang-Fu Sun
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, 110002, PR China
| | - Fa-Yu Liu
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, 110002, PR China.
| |
Collapse
|
3
|
Das A, Kakati K, Das K, Reddy GGSS. Modified nasolabial flap- the nasomentolabial flap: A new arrow in surgeon's quiver. Oral Oncol 2022; 125:105697. [PMID: 34999417 DOI: 10.1016/j.oraloncology.2021.105697] [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: 12/11/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
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.
Collapse
|
4
|
Kshirsagar R, Mohite A, Gupta S, Patankar A, Sane V, Raut P. Complications in the use of bilateral inferiorly based nasolabial flaps for advanced oral submucous fibrosis. Natl J Maxillofac Surg 2016; 7:115-121. [PMID: 28356681 PMCID: PMC5357923 DOI: 10.4103/0975-5950.201358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Surgical management of advanced oral submucous fibrosis (OSMF) using bilateral inferiorly based nasolabial flaps is becoming increasingly popular. However no comprehensive analysis of delayed complications using this technique is available in the literature. The authors have conducted a retrospective study to examine the delayed complications of bilateral inferiorly based nasolabial flaps used in advanced oral submucous fibrosis at their institute along with a detailed review of literature on the subject. Thirty-two patients from January 2004 to December 2015 with OSMF and an interincisal distance less than 15 mm were included. All patients were treated with bilateral inferiorly based nasolabial flaps for correction of the restricted mouth opening. All patients had postoperative physiotherapy and were followed up for a minimum period of 6 months. All complaints of patients during the follow up phase were included in this study. In this series, complications such as partial necrosis, intra-oral hair growth, unacceptable extra-oral scar, wound dehiscence, orocutaneous fistula, and pincushioning effect were observed. Numerous complications can occur with the use of nasolabial flaps for the management of advanced oral submucous fibrosis. Although most complications are of inconsequential nature the surgeon must observe due diligence when using this flap.
Collapse
Affiliation(s)
- Rajesh Kshirsagar
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
| | - Ajay Mohite
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
| | - Suman Gupta
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
| | - Amod Patankar
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
| | - Vikrant Sane
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
| | - Pratik Raut
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
| |
Collapse
|
5
|
Nueangkhota P, Liang YJ, Zheng GS, Su YX, Yang WF, Liao GQ. Reconstruction of Tongue Defects With the Contralateral Nasolabial Island Flap. J Oral Maxillofac Surg 2015; 74:851-9. [PMID: 26549474 DOI: 10.1016/j.joms.2015.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/08/2015] [Accepted: 10/08/2015] [Indexed: 11/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Pajjai Nueangkhota
- Resident, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Yu-jie Liang
- Lecturer, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Guang-sen Zheng
- Lecturer, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Yu-xiong Su
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Wei-fa Yang
- Resident, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Gui-qing Liao
- Professor and Chief, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
6
|
Unilateral one stage nasolabial flap for reconstruction of the lips. J Maxillofac Oral Surg 2015; 14:234-9. [PMID: 26028840 DOI: 10.1007/s12663-013-0615-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/28/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Nasolabial flap (NLF) is one of the oldest described soft tissue flaps. Despite the great advances in maxillofacial reconstruction it still has a stable location in the reconstructive ladder of the face and oral cavity. Reconstruction of the lips, which are important structures that connect the oral cavity to the facial skin, with this flap is the interest of the surgeons. PATIENTS AND METHODS Experience of the authors for reconstruction of the upper lip philtrum, correction of lower lip contracture and subtotal reconstruction of the lower lip with emphasis on simultaneous correction of the red lip (volume and color) is explained in five cases. RESULTS Satisfactory functional and aesthetic results were obtained. Iatrogenic epidermoid cyst occurred in one patient. CONCLUSION One stage reconstruction of lateral lower lip defects with/without commissural involvement in full or partial thickness defects is possible by NLF. Supplementary flaps are needed when the vermilion needs simultaneous reconstruction.
Collapse
|