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Chen Y, Zhong NN, Cao LM, Liu B, Bu LL. Surgical margins in head and neck squamous cell carcinoma: A narrative review. Int J Surg 2024; 110:3680-3700. [PMID: 38935830 PMCID: PMC11175762 DOI: 10.1097/js9.0000000000001306] [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: 12/27/2023] [Accepted: 02/26/2024] [Indexed: 06/29/2024]
Abstract
Head and neck squamous cell carcinoma (HNSCC), a prevalent and frequently recurring malignancy, often necessitates surgical intervention. The surgical margin (SM) plays a pivotal role in determining the postoperative treatment strategy and prognostic evaluation of HNSCC. Nonetheless, the process of clinical appraisal and assessment of the SMs remains a complex and indeterminate endeavor, thereby leading to potential difficulties for surgeons in defining the extent of resection. In this regard, we undertake a comprehensive review of the suggested surgical distance in varying circumstances, diverse methods of margin evaluation, and the delicate balance that must be maintained between tissue resection and preservation in head and neck surgical procedures. This review is intended to provide surgeons with pragmatic guidance in selecting the most suitable resection techniques, and in improving patients' quality of life by achieving optimal functional and aesthetic restoration.
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Affiliation(s)
- Yang Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
| | - Nian-Nian Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
| | - Lei-Ming Cao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
- Department of Oral & Maxillofacial – Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, People’s Republic of China
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
- Department of Oral & Maxillofacial – Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, People’s Republic of China
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Isazadeh AR, Seikaly H, Westover L, Aalto D. Algorithmically designed flaps in tongue reconstruction: a feasibility analysis. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03062-w. [PMID: 38236478 DOI: 10.1007/s11548-024-03062-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/05/2024] [Indexed: 01/19/2024]
Abstract
PURPOSE Despite the significance and complexity of tongue reconstruction surgery, a digital tool for flap design is currently lacking. This study investigates the effectiveness of employing inverse finite element method (IFEM) for meticulously designing the geometric characteristics of harvested tissue (free flap) for tongue reconstruction. METHODS In the case of an artificially simulated hemiglossectomy, IFEM algorithm was applied for algorithmic flap design. The method's effectiveness was evaluated by assessing flap deformation in a simplified virtual reconstruction, focusing on parameters such as stress, strain, and thickness. RESULTS The IFEM algorithm successfully generated an optimal flap design for the intended surgical removal. Analysis of the flap's overall surface area, deformation characteristics, and safety margins demonstrated the feasibility of the deformation. Notably, the stress and thickness assessments suggested that the flap's tension post-surgery would not adversely affect the mobility of the reconstructed tongue, suggesting a positive outcome for functional recovery. CONCLUSION The IFEM demonstrates significant potential as a tool for precise free flap design in tongue reconstruction surgeries. Its application could lead to improved surgical accuracy and better quality of life for patients undergoing such procedures.
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Affiliation(s)
- Amir Reza Isazadeh
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, 6-129 Clinical Sciences Building, 11304 - 83 Ave NW, Edmonton, AB, T6G 2G3, Canada
| | - Hadi Seikaly
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, Canada
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Canada
| | - Daniel Aalto
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, 6-129 Clinical Sciences Building, 11304 - 83 Ave NW, Edmonton, AB, T6G 2G3, Canada.
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, Canada.
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Liu MD, Xue XM, Al-Aroomi MA, Xiong JJ, Liu S, Sun CF, Liu FY. A novel flap design technique for subtotal tongue reconstruction with an "Individualized and Convenient Tongue Model". Oral Oncol 2023; 145:106531. [PMID: 37499327 DOI: 10.1016/j.oraloncology.2023.106531] [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: 01/09/2023] [Revised: 06/22/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND To achieve improved functional outcomes in subtotal tongue reconstruction, a flap design with sufficient volume and appropriate shape is necessary. In this study, we introduce an "Individualized and Convenient Tongue Model" (ICTM) for flap design in subtotal tongue reconstruction. METHODS By studying the anatomical morphology of the tongue, we found a similar geometry within the dorsum and body of the tongue as well as the mouth floor. This can be used to create an ICTM through folding and splicing. We can simulate tongue defects in the ICTM and transform defect shapes into guide plates for flap design. In this study, fifty-eight patients requiring subtotal tongue reconstruction were randomly divided into two groups: an ICTM group (35 patients) and a conventional group (31 patients). In the ICTM group, we individually designed profunda artery perforator flaps (PAPFs) or anterolateral thigh flaps (ALTFs) using the ICTM method. In the conventional group, the flap was designed according to the surgeon's clinical experience. Patient demographics, operative and follow-up data were recorded. Swallowing, speech intelligibility, and cosmetic results were assessed using appropriate scales. RESULTS All flaps survived, although there were no significant differences in tumor size, operation time, flap size, and complication rate compared to the conventional group. Patients in the ICTM group had significantly improved speech intelligibility (p = 0.019), cosmetic appearance (p = 0.009), and swallowing ability (p = 0.003). CONCLUSIONS The ICTM technique is an effective and convenient solution for subtotal tongue reconstruction that provides an individualized flap design and improves functional outcomes compared to the conventional design.
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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.
| | - Xiao-Meng Xue
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR 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.
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Liu S, Zhang S, Su YX, Zhou X, Gong ZJ, Wu HJ. Optimization of total tongue functional reconstruction with the sushi roll technique and its application in pectoralis major myocutaneous flaps. Int J Oral Maxillofac Surg 2023:S0901-5027(23)00003-6. [PMID: 36653273 DOI: 10.1016/j.ijom.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
A protuberant shape and sufficient volume are the most important parameters for total tongue reconstruction. The conventional pectoralis major myocutaneous (PMMC) flap undergoes collapse due to atrophy of the denervated muscle. In a new technique, this flap was rolled up like sushi to reshape the neotongue. This study explored the feasibility and effect of the 'sushi roll' technique for precise total functional reconstruction of the tongue using a PMMC flap. Thirty patients scheduled for total glossectomy and PMMC flap reconstruction were recruited. The sushi roll technique was performed in 15 patients and the conventional repair in 15 patients. Outcomes were compared between the two groups. The flap survived in all 30 patients. The sushi roll group showed superior results to the conventional group in terms of time to oral alimentation (P = 0.012) and decannulation (P = 0.041), as well as swallowing function (P = 0.032), speech intelligibility (P < 0.001), shape (P < 0.001), and quality of life score (P < 0.001) at 12 months. The innovative sushi roll technique uses a folding method that utilizes the length rather than the thickness and width of the flap to maintain the volume and protuberance of the neotongue, which results in acceptable function and improved quality of life.
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Affiliation(s)
- S Liu
- Discipline of Oral and Maxillofacial Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - S Zhang
- Discipline of Oral and Maxillofacial Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Y-X Su
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong, China
| | - X Zhou
- Discipline of Oral and Maxillofacial Surgery, Second Xiangya Hospital, Central South University, Changsha, China.
| | - Z J Gong
- Discipline of Oral and Maxillofacial Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - H J Wu
- Discipline of Oral and Maxillofacial Surgery, Second Xiangya Hospital, Central South University, Changsha, China
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Cai T, Chen S, Li Q, Fang Z, Cao H, Xie Z, Liu N, Li Y, Ye X, Li J, Fan S. The Tai Chi Flap: A Novel Design for the Radial Forearm Flap. Ann Plast Surg 2022; 89:59-62. [PMID: 35502975 DOI: 10.1097/sap.0000000000003149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Tai Chi is an ancient philosophy used to explain the universe. The Tai Chi symbol is represented by Yin/Yang fishes. The authors describe a novel radial forearm flap (RFF) design for the reconstruction of circular defects based on the Tai Chi symbol. METHODS Eleven consecutive patients with craniofacial skin or mucus defects underwent reconstruction with a Tai Chi RFF. Patient perioperative and follow-up information was collected. RESULTS The diameter of the Tai Chi RFF was 5 to 6 cm. All flaps healed uneventfully without ischemic problems, and all donor site defects were closed primarily without skin grafts. Remarkably, 2 patients received a tattoo to mark the Tai Chi symbol and greatly appreciate the shape of the flap. CONCLUSIONS The Tai Chi flap is an economically friendly flap design that can be used to prevent skin grafts while providing psychological comfort to patients.
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Affiliation(s)
- Tingting Cai
- From the Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation
| | | | | | - Zezhen Fang
- Department of Oral and Maxillofacial Surgery
| | - Haotian Cao
- Department of Oral and Maxillofacial Surgery
| | - Zhijun Xie
- Department of Oral and Maxillofacial Surgery
| | - Niu Liu
- From the Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation
| | - Yanyan Li
- Department of Oral and Maxillofacial Surgery
| | - Xiuhua Ye
- Department of Prosthodontics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jinsong Li
- Department of Oral and Maxillofacial Surgery
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Utility of a palatal speech appliance combined with the five-point eight-line segment technique in total tongue reconstruction. Int J Oral Maxillofac Surg 2022; 51:1016-1021. [DOI: 10.1016/j.ijom.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/20/2021] [Accepted: 01/05/2022] [Indexed: 11/19/2022]
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Zhou X, He ZJ, Su YX, Zhang S, Gong ZJ, Wu HJ. "Sushi roll" technique for precise total tongue functional reconstruction using a pre-sutured femoral anterolateral myocutaneous flap. Oral Oncol 2020; 110:104866. [PMID: 32623343 DOI: 10.1016/j.oraloncology.2020.104866] [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: 02/05/2020] [Revised: 05/12/2020] [Accepted: 06/15/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Reconstruction of the total tongue after cancer resection remains one of the challenges in head and neck surgery. Inadequate reconstruction after subtotal or total glossectomy defects leads to poor quality of life. The aim of this study was to explore an economical, practical and effective flap design for functional tongue reconstruction. MATERIAL AND METHODS Sixty patients were randomly divided into two groups, namely, a "Sushi roll" technique group (30 patients) and a conventional surgery group (30 patients). Then, the patients underwent total or subtotal tongue reconstruction. Swallowing function, speech intelligibility, cosmetic results, and quality of life were assessed with the appropriate scales. Outcomes were analysed, and a p-value <0.05 was considered significant. RESULTS The perioperative recovery of the "Sushi roll" group was superior to that of the conventional group. Relative to patients in the conventional group, patients in the "Sushi roll" group showed significantly improved speech intelligibility (p = 0.025), cosmetic results (p < 0.001) and swallowing function (p < 0.001). CONCLUSION The innovative "Sushi roll" anterolateral thigh myocutaneous flap approach for total tongue reconstruction creates a free neotongue tip with adequate volume and protuberance and causes minimal damage to the donor site, producing acceptable swallowing function and speech intelligibility.
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Affiliation(s)
- Xi Zhou
- Lecturer, Discipline of Oral & Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Zhi-Jing He
- Lecturer, Discipline of Oral & Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yu-Xiong Su
- Associate Professor, Discipline of Oral & Maxillofacial Surgery, Faculty of Dentistry, the University of Hong Kong, Hong Kong, China
| | - Sheng Zhang
- Professor and Chief, Discipline of Oral & Maxillofacial Surgery, The Second Xiangya hospital, Central South University, Changsha, China
| | - Zhao Jian Gong
- Associate Professor, Discipline of Oral & Maxillofacial Surgery, The Second Xiangya hospital, Central South University, Changsha, China
| | - Han Jiang Wu
- Professor and Chief, Discipline of Oral & Maxillofacial Surgery, The Second Xiangya hospital, Central South University, Changsha, China
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