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Gur E, Tiftikcioglu YO, Kuybulu TF, Durukan K, Bekir HH, Ozturk K. Use of the pedicle of previously harvested pectoral myocutaneous flap as a recipient for free flaps in head and neck reconstruction. Microsurgery 2024; 44:e31175. [PMID: 38553853 DOI: 10.1002/micr.31175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 02/12/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION The pectoral myocutaneous flap (PMF) is a workhorse regional reconstructive option for head and neck defects. It is commonly used for primary reconstructions due to its advantages or as a life-boat flap in the salvage of failed reconstructions of free flaps. However, it also has intrinsic drawbacks, such as perfusion problems and partial or complete flap loss. Although there are many studies about the advantages and use of PMF in the literature, the number of studies about salvage of this workhorse flap is inadequate. We aimed to present the use of the pedicle of previously performed PMF as a recipient for free flaps in head and neck reconstruction. METHODS Between January 2022 and August 2023, 10 free flaps were used in nine patients (three females and six males) who had previously undergone head and neck reconstruction with PMF. The age of the patients ranged from 54 to 74 years. Seven out of the nine PMFs were previously performed by different surgical teams. Squamous cell carcinoma (SCC) was the reason for primary surgeries in all patients and the PMFs were used for right lower lip and right submandibular defect, left lower lip and mentum defect, lower lip defect, right lower lip and right submandibular defect, right retromolar trigone defect, right buccal defect, left anterolateral esophageal defect, right retromolar trigone defect and left anterolateral pharyngoesophageal defect reconstructions. The problems were partial skin island necrosis and wound dehiscence in six patients and total skin necrosis in three patients. The partial skin island necroses already showed that the pedicles were unproblematic. For patients with total skin island necrosis the muscle stalks so the pedicles were also unproblematic which were confirmed by physical examination and Doppler device. After complications, the finally defects were located in the lower lip, left lower lip and mentum, right lower lip and right submandibular area, left anterolateral esophageal area and left neck, right buccal area, right retromolar trigon, left anterolateral pharyngoesophageal fistula and left neck. The sizes of the defects were between 3 × 4 cm and 11 × 17 cm. For all patients, the pedicle of the previously harvested PMF was used as a recipient for free flaps. Since the PMF was flipped over the clavicula for the reconstruction previously, the pedicle was so close to skin or skin graft which was used for coverage of the muscle stalk. The Doppler device was used first over the clavicle where the PMF was flipped for vessel identification. After marking the vessels, a vertical zigzag incision was made on the skin or skin graft. The perivascular fatty tissue and the pedicle were encountered with minimal dissection by the guidance of Doppler. After meticulous microscopic dissection, the pedicle of PMF was prepared for anastomoses as usual. Six radial forearm free flap (RFFF) and four anterolateral thigh flap (ALT) flaps were used in the head and neck reconstructions for the nine patients. RESULTS The sizes of the flaps were between 4 × 5 cm and 12 × 17 cm. The diameters of the recipient arteries were between 0.9 and 1.2 mm. Recipient veins were approximately the same diameter as the arteries. In one patient, two vein grafts were used for lengthening both the artery and vein to reach recipient vessels. End-to-end anastomoses without vein grafts were performed in the remaining patients. One arterial thrombosis that manifested on the first postoperative day was salvaged successfully. Hematoma was seen in two patients and wound dehiscence was seen in three patients. There was no partial or total flap necrosis and all flaps survived. The follow-up period ranged from 2 to 12 months. Despite successful reconstructions, two patients died during the follow-up period due to unrelated conditions. Functional results were acceptable in the remaining patients. CONCLUSION The pedicle of previously used pectoral myocutaneous flaps may be a useful alternative option as the recipient for free flaps in head and neck reconstruction.
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Affiliation(s)
- Ersin Gur
- Department of Plastic Reconstructive and Aesthetic Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Yigit Ozer Tiftikcioglu
- Department of Plastic Reconstructive and Aesthetic Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Turgut Furkan Kuybulu
- Department of Plastic Reconstructive and Aesthetic Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Kutay Durukan
- Department of Plastic Reconstructive and Aesthetic Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Hamit Hakan Bekir
- Department of Plastic Reconstructive and Aesthetic Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Kerem Ozturk
- Department of Ear, Nose and Throat, Ege University Faculty of Medicine, Izmir, Turkey
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Deot N, Tatum SA. Revision Palate Surgery. Facial Plast Surg Clin North Am 2024; 32:63-68. [PMID: 37981417 DOI: 10.1016/j.fsc.2023.05.003] [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] [Indexed: 11/21/2023]
Abstract
Oronasal fistulae and velopharyngeal insufficiency are common and interdependent complications after cleft palate surgery. Bone grafting can complement cleft habilitation. Early identification and intervention are vital for optimal outcomes. Collaboration with experienced healthcare professionals is crucial to develop a comprehensive treatment plan which considers speech therapy, prosthetic devices, and surgery. This article aims to review the current literature on the management of VPI and oronasal fistulae following cleft palate surgery and additionally highlight the role of alveolar bone grafting to improve outcomes for these patients.
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Affiliation(s)
- Neal Deot
- Department of Otolaryngology, Upstate Medical University, Syracuse, NY, USA.
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Brar GK, Keshav V, Sodhi SPS, Chawla U, Sodhi A. A Rare Complication of Maxillary Third Molar Extraction. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S983-S986. [PMID: 38595480 PMCID: PMC11001058 DOI: 10.4103/jpbs.jpbs_947_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 04/11/2024] Open
Abstract
The removal of tuberosity post extraction of the maxillary third molar is a very rare complication and there has not been ample discussion in the literature. Forceful extraction of a maxillary third molar can lead to soft and hard tissue loss. Various techniques have been used for the management of such defects such as local flaps, free soft tissue flaps, free bone flaps, and even tissue engineering. We present a case report of a large post-traumatic defect of maxillary tuberosity caused by forceful extraction of the maxillary third molar, which was managed conservatively by secondary healing, and the patient is on regular follow-up.
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Affiliation(s)
- Gursimrat Kaur Brar
- Department of Oral and Maxillofacial Surgery, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India
| | - Vanita Keshav
- Department of Conservative Dentistry and Endodontics, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India
| | - Surender Pal Singh Sodhi
- Department of Oral and Maxillofacial Surgery, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India
| | - Ujjwal Chawla
- Department of Oral and Maxillofacial Surgery, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India
| | - Asmita Sodhi
- Department of Prosthodontics, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India
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Rahpeyma A, Khajehahmadi S. Temporoparietal Flap for Facial Reconstruction: Donor Site Morbidity. World J Plast Surg 2024; 13:87-91. [PMID: 38742035 PMCID: PMC11088726 DOI: 10.61186/wjps.13.1.87] [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: 10/15/2023] [Accepted: 01/10/2024] [Indexed: 05/16/2024] Open
Abstract
Background Temporoparietal flap (TPF) is recommended when thin delicate tissue for medium sized defect is needed. The most used form of this flap is for auricle reconstruction. In this article usage of this flap for facial reconstruction other than auricle is discussed, emphasing on donor site morbidity. Method In this retrospective study, archived files of the Department of Oral and Maxillofacial Surgery, University of Medical Sciences, Mashhad, Iran were evaluated from 2016-2020. Patients whom TPF was used for facial reconstruction were included. Flap survival was checked and donor site morbidity was evaluated in the form of skin scar and frontal nerve branch injury. Results This flap was used in 8 patients for facial reconstruction. All the cases had experienced Alopecia and this was the greatest when the skin of scalp was also included. All of the patients could elevate the eyebrow that means intact frontal branch of facial nerve. Conclusion TPF is a versatile flap for facial reconstruction. However, alopecia is high in composite fasciocutaneous form of this flap.
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Affiliation(s)
- Amin Rahpeyma
- Oral & Maxillofacial Diseases Research Center, University of Medical Sciences, Mashhad, Iran
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Medical Sciences, Mashhad, Iran
| | - Saeedeh Khajehahmadi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Medical Sciences, Mashhad, Iran
- Dental Research Center, University of Medical Sciences, Mashhad, Iran
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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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Modified Technique of Pectoralis Major Myocutaneous Flap Inset for Buccal Mucosa Reconstruction. World J Plast Surg 2022; 11:83-89. [PMID: 36117907 PMCID: PMC9446115 DOI: 10.52547/wjps.11.2.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
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Effect of Amniotic Membrane Nerve Wrapping in Final Results of Traumatic Peripheral Nerve Repair. World J Plast Surg 2022; 11:90-94. [PMID: 36117898 PMCID: PMC9446123 DOI: 10.52547/wjps.11.2.90] [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: 12/22/2021] [Accepted: 02/12/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Preventing perineural adhesions and scars formation in the traumatic peripheral injuries is very important on the recovery process. We aimed to evaluate the effect of using the amniotic membrane wrapping on the results of surgical treatment of damaged peripheral nerves. METHODS This cohort study included 30 patients with symptoms of acute peripheral nerve injuries due to penetrating trauma in the forearm or wrist in January 2019 to November 2020 referred to the Hand and Microsurgery Department, 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. In 15 patients, after nerve repair, amniotic membrane coverage was used around the nerve, all patients were followed for 12 months. Ultrasound study for neuroma formation and nerve regeneration was determined based on EMG and NCV findings. The modified Medical Research Councile classification (MRCC) was used to evaluate of motor and sensory recovery. RESULTS In the amniotic membrane wrapping group, all patients had nerve regeneration and functional nerve recovery occurred after 12 months. In the control group, 5 patients (33.4%) did not have nerve recovery and had functional and sensory impairment. In terms of functional capabilities; there was a significant difference in pinch strength, grip power and MRCC scoring between the two groups. Moreover, the mean volume of neuroma in these patients who used amniotic membrane covering was 2.7 mm3 and in the control group, it was 3.9 mm3 (P=0.001). Five patients who did not have a damaged nerve, the neuroma volume was 4.8 ± 0.9 mm3. CONCLUSION The use of amniotic membrane covering is effective methods in the improve results of peripheral nerve repair and nerve function recovery.
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Matsuura‐Midorikawa M, Rikimaru H, Rikimaru‐Nishi Y, Migita H, Tanaka H, Oyama M, Kiyokawa K. Indication for management of oropharyngocutaneous fistulas after head and neck reconstruction using a "stick-shaped platysma flap" technique. Clin Case Rep 2021; 9:e04135. [PMID: 34336209 PMCID: PMC8319381 DOI: 10.1002/ccr3.4135] [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: 02/28/2021] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 11/06/2022] Open
Abstract
The main strength of the stick-shaped platysma flap technique is it provides adequate tissue volume, while being comparatively simple to perform. It is a highly efficient and straightforward method to close intractable fistulas with minimal morbidity.
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Affiliation(s)
- Mari Matsuura‐Midorikawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
| | - Hideaki Rikimaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
| | - Yukiko Rikimaru‐Nishi
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
- Division of Microscopic and Developmental AnatomyDepartment of AnatomyKurume University School of MedicineKurumeJapan
| | - Hisashi Migita
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
| | - Hiroaki Tanaka
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
| | - Mai Oyama
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
| | - Kensuke Kiyokawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
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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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Papadopoulos KS, Pantazidou G, Karagkouni E, Papadopoulos G, Papaioannou I. Local Mucosal Flap for the Treatment of Gingival Defect After Gingival Fibromatosis Excision. Cureus 2020; 12:e12016. [PMID: 33437556 PMCID: PMC7793370 DOI: 10.7759/cureus.12016] [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] [Indexed: 11/28/2022] Open
Abstract
Gingival fibromatosis (GF) is a rare condition of fibrous enlargement of the gingivae causing functional or aesthetic problems. We report a case of localized GF in a 51-year-old healthy male patient who presented in our department with localized gingival enlargement. We performed gingivectomy and restored the defect with a novel local transpositional mucosal flap with excellent functional and aesthetic results. This type of intervention is accompanied by short surgical time, provides predictable results, and should be considered in adult patients with large defects from sizable lesions.
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Affiliation(s)
| | - Georgia Pantazidou
- Otolaryngology - Head and Neck Surgery, General Hospital of Patras, Patras, GRC
| | - Eleni Karagkouni
- Otolaryngology - Head and Neck Surgery, General Hospital of Patras, Patras, GRC
| | - George Papadopoulos
- Otolaryngology - Head and Neck Surgery, General Hospital of Patras, Patras, GRC
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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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Cordova A, D'Arpa S, Rosatti F, Nichelini M, D'Antonio GM, Giordano S, Toia F. Propeller Flaps in the Head and Neck. Semin Plast Surg 2020; 34:165-170. [PMID: 33041686 DOI: 10.1055/s-0040-1714269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Propeller flaps have significantly expanded the reconstruction possibilities in the head and neck region. They allow for increased flap mobility and better scar concealing, and/or to perform a one-stage reconstruction with local tissue of similar color and texture, where multiple surgeries would be needed with traditional flaps or even free flaps would be required. This article describes the main propeller flaps for one-stage reconstruction in the head-neck region (facial artery perforator, supratrochlear artery axial perforator, deep lingual artery axial perforator, and anterior supraclavicular artery perforator flaps), their indications, and possible complications. Aesthetic and functional results of propeller flaps in the head and neck region are very good and the complication rate is low, but due to their surgical complexity and the availability of many simpler local flaps, they are indicated only in select cases where local flaps are unavailable or would require multiple staged procedures to complete the construction.
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Affiliation(s)
- Adriana Cordova
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore D'Arpa
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Fernando Rosatti
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Marta Nichelini
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giovanni Maria D'Antonio
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore Giordano
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesca Toia
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Rahpeyma A, Khajehahmadi S. Donor Site Morbidity in Submental Flap: Emphasizing on Facial Hairs Direction. Ann Maxillofac Surg 2020; 10:133-135. [PMID: 32855929 PMCID: PMC7433961 DOI: 10.4103/ams.ams_215_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/09/2019] [Accepted: 12/01/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Donor site morbidity is an important factor for selecting a flap for reconstruction. Submental flap using submentum skin for reconstruction has low donor site morbidity. Up to now, donor site morbidity of submental flap in Caucasians has not been evaluated. Materials and Methods In a retrospective study, donor site morbidity of the submental flap including changes in hair direction, hypertrophic scars, and suture marks was evaluated. Results Forty patients with at least 2 years of follow-up were evaluated. Female patients indicated better esthetic results. Abrupt beard hair direction change occurred in five male patients. Two hypertrophic scars and one suture mark were recorded. Conclusion The direction of beard hairs in submentum may be changed after submental flap harvest. Accordingly, this is important in some ethnic and religious groups.
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Affiliation(s)
- Amin Rahpeyma
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeedeh Khajehahmadi
- Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Oral and Maxillofacial Pathology, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Samizadeh S, Pirayesh A, Bertossi D. Anatomical Variations in the Course of Labial Arteries: A Literature Review. Aesthet Surg J 2019; 39:1225-1235. [PMID: 30204834 DOI: 10.1093/asj/sjy235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nonsurgical lip enhancement using dermal fillers is a very popular procedure. The trend for enlarged lips has been popularized by media and social media. The lips have considerable aesthetic and functional importance, in addition to having a complex anatomy. Serious complications, including vascular compromise or occlusion leading to cutaneous necrosis and blindness, can occur as the result of lip enhancement using dermal fillers. Therefore, aesthetic practitioners require an in-depth understanding of the anatomy and vasculature of the lips and the perioral area prior to providing lip enhancement using dermal fillers. OBJECTIVES This literature review aimed to summarize existing data describing the origin, path, and depth of the superior and inferior labial arteries, and to help aesthetic practitioners in providing safer injections to the lips. METHODS A literature search was carried out to summarize the available data describing the origin, path, and depth of the labial arteries. RESULTS Analysis of the literature revealed that the labial arteries display great variability with respect to path (distribution), presence, and location. CONCLUSIONS Increasing the volume of lips through injections of dermal filler needs to be undertaken with caution, and awareness of the anatomical variation in artery location and path is a crucial concept that is essential when injecting the lips.
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Affiliation(s)
| | | | - Dario Bertossi
- Maxillofacial and ENT Surgeon, University of Verona, Verona, Italy
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16
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Meier JK, Schuderer JG, Zeman F, Klingelhöffer C, Hullmann M, Spanier G, Reichert TE, Ettl T. Health-related quality of life: a retrospective study on local vs. microvascular reconstruction in patients with oral cancer. BMC Oral Health 2019; 19:62. [PMID: 31029131 PMCID: PMC6487048 DOI: 10.1186/s12903-019-0760-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/09/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND New medicinal and surgical oncological treatment strategies not only improve overall survival rates but continually increase the importance of Health-Related Quality of Life (HRQOL). The purpose of this retrospective cross-sectional study was to analyze HRQOL of patients with oral squamous cell carcinoma after ablative surgery and to evaluate predictive factors for HRQOL outcome. METHODS The study included 88 patients with histologically confirmed oral squamous cell carcinoma of whom 42 had undergone local reconstruction (LR) and 46 microvascular reconstruction (MVR). During follow-up, all patients completed the University of Washington Quality of Life Questionnaire (UW-QOL) containing 12 targeted questions about the head and neck. Descriptive analyses were made for the tumor site, the T-stage, and adjuvant therapies. HRQOL was compared between the LR and the MVR group with parametric tests. Further analyses were impact of the tumor site, the T-status, and the time from surgery to survey on HRQOL. Statistics also included multivariate correlations and different interaction effects. RESULTS HRQOL in the LR group was 'very good' with 84.3 ± 13.7 and 'good' in the MVR group with 73.3 ± 16.5 points. The physical domains swallowing (p = 0.00), chewing (p = 0.00), speech (p = 0.01), taste (p = 0.01), and pain (p = 0.04) were significantly worse in the MVR group. An increase in the T-status had a significant negative effect on swallowing (p = 0.01), chewing (p = 0.01), speech (p = 0.03), recreation (p = 0.05), and shoulder (p = 0.01) in both groups. Regarding the tumor site and subsequent loss of HRQOL, patients with squamous cell carcinoma on the floor of the mouth had significantly worse results in the categories pain (p = 0.002), speech (p = 0.002), swallowing (p = 0.03), activity (p = 0.02), and recreation (p = 0.01) than patients with tumors in the buccal mucosa. Speech (p = 0.03) and pain (p = 0.01) had improved 1 year after surgery. CONCLUSION Patients with flap reconstruction because of oral squamous cell carcinoma showed very good overall HRQOL. Outcomes for microvascular reconstruction were good, even in the case of larger defects. The T-status is a predictor for HRQOL. Swallowing, chewing, speaking, taste, and pain were the most important issues in our cohort. Implementing HRQOL questionnaires for the assessment of quality of life could further increase the treatment quality of patients with oral cancer.
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Affiliation(s)
- J K Meier
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany.
| | - J G Schuderer
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - F Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - Ch Klingelhöffer
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - M Hullmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - G Spanier
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - T E Reichert
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - T Ettl
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
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17
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Chiang TE, Lin YC, Chang WC, Chen YW. The nasolabial subcutaneous pedicle flap for lower-lip defect reconstruction. J Dent Sci 2019; 13:177-178. [PMID: 30895116 PMCID: PMC6388862 DOI: 10.1016/j.jds.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 08/27/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tien-En Chiang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Tri-Service General Hospital, Taiwan, ROC.,School of Dentistry, National Defense Medical Center, Taiwan, ROC.,Department of Pathology, Tri-Service General Hospital, Taiwan, ROC.,Division of Oral and Maxillofacial Surgery, Department of Dentistry, Tri-Service General Hospital, Taiwan, ROC.,School of Dentistry, National Defense Medical Center, Taiwan, ROC
| | - Yu-Chun Lin
- Department of Pathology, Tri-Service General Hospital, Taiwan, ROC.,Division of Oral and Maxillofacial Surgery, Department of Dentistry, Tri-Service General Hospital, Taiwan, ROC.,School of Dentistry, National Defense Medical Center, Taiwan, ROC
| | - Wei-Chin Chang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Tri-Service General Hospital, Taiwan, ROC.,School of Dentistry, National Defense Medical Center, Taiwan, ROC
| | - Yuan-Wu Chen
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Tri-Service General Hospital, Taiwan, ROC.,School of Dentistry, National Defense Medical Center, Taiwan, ROC
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Abstract
Rationale: In the last decade, the incidence of skin cancers has been increasing. Early diagnosis, treatment and prevention are crucial in helping to diminish the incidence, mortality and morbidity associated with skin cancers. Objective: This article presents arguments for and against local anesthesia in the treatment of skin cancers, including the clinical cases, a summary of treatment, and prognosis. Methods and results: Under local anesthesia, local and loco-regional flaps offer an optimal shape and volume for face reconstruction, minimizing the operative time and therefore the hospitalization. Facial skin cancer surgery under local anesthesia also contributes significantly to decreasing health care costs compared to general anesthesia. Discussions: Although in our practice, excision of skin tumors in the facial area under local anesthesia is a frequent and harmless surgical method, it can cause increased stress in some patients. However, the benefits are significantly greater than the disadvantages.
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Affiliation(s)
- Anca Bordianu
- "Bagdasar-Arseni" Emergency Hospital, Plastic and Reconstructive Department, University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
| | - Florin Bobirca
- "Dr I. Cantacuzino" Hospital, General Surgery Department, Bucharest, Romania
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19
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Mahieu R, Colletti G, Bonomo P, Parrinello G, Iavarone A, Dolivet G, Livi L, Deganello A. Head and neck reconstruction with pedicled flaps in the free flap era. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 36:459-468. [PMID: 28177328 PMCID: PMC5317124 DOI: 10.14639/0392-100x-1153] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/19/2016] [Indexed: 01/30/2023]
Abstract
Nowadays, the transposition of microvascular free flaps is the most popular method for management of head and neck defects. However, not all patients are suitable candidates for free flap reconstruction. In addition, not every defect requires a free flap transfer to achieve good functional results. The aim of this study was to assess whether pedicled flap reconstruction of head and neck defects is inferior to microvascular free flap reconstruction in terms of complications, functionality and prognosis. The records of consecutive patients who underwent free flap or pedicled flap reconstruction after head and neck cancer ablation from 2006 to 2015, from a single surgeon, in the AOUC Hospital, Florence Italy were analysed. A total of 93 patients, the majority with oral cancer (n = 59), were included, of which 64 were pedicled flap reconstructions (69%). The results showed no significant differences in terms of functional outcome, flap necrosis and complications in each type of reconstruction. Multivariate regression analysis of flap necrosis and functional impairments showed no associated factors. Multivariate regression analysis of complicated flap healing showed that only comorbidities remained an explaining factor (p = 0.019). Survival analysis and proportional hazard regression analysis regarding cancer relapse or distant metastasis, showed no significant differences in prognosis of patients concerning both types of reconstruction. In this retrospective, non-randomised study cohort, pedicled flaps were not significantly inferior to free flaps for reconstruction of head and neck defects, considering functionality, complications and prognosis.
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Affiliation(s)
- R Mahieu
- Department of Surgery and Translational Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.,University of Groningen, University Medical Center Groningen, the Netherlands
| | - G Colletti
- Department of Maxillo-facial Surgery, University of Milan, Milan, Italy
| | - P Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - G Parrinello
- Department of Surgery and Translational Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - A Iavarone
- Department of Surgery and Translational Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - G Dolivet
- Department of Oncologic Surgery l'institut de Cancérologie de Lorraine, Nancy, France
| | - L Livi
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - A Deganello
- Department of Surgery and Translational Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
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20
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Inferiorly Pedicled Nasolabial Flap for Reconstruction of Anterior Maxilla Defects Class I and II. J Craniofac Surg 2017; 29:457-459. [PMID: 29239921 DOI: 10.1097/scs.0000000000004203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Schonauer F, Di Martino A, Nele G, Santoro M, Dell’Aversana Orabona G, Califano L. Submental flap as an alternative to microsurgical flap in intraoral post-oncological reconstruction in the elderly. Int J Surg 2016; 33 Suppl 1:S51-6. [DOI: 10.1016/j.ijsu.2016.05.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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23
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Random Cheek Skin Flap: a Simple Alternative for Intraoral Defects. Indian J Surg 2016; 77:551-3. [PMID: 26884671 DOI: 10.1007/s12262-015-1342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 09/02/2015] [Indexed: 10/23/2022] Open
Abstract
Oral cavity squamous cell carcinoma is one of the common cancers in India. The lesion usually presents as an ulcer and sometimes as a nodule. A variety of premalignant lesions and submucous fibrosis are common. The mucosal defect after resection needs to be covered. We present a new and simpler way of reconstruction of the oral cavity lining by using extra cheek skin.
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The soft tissue landmarks to avoid injury to the facial artery during filler and neurotoxin injection at the nasolabial region. J Craniofac Surg 2015; 25:1885-9. [PMID: 25098578 DOI: 10.1097/scs.0000000000001003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to locate the course of the facial artery and to propose "the danger line" vulnerable to vascular complications following filler injection. The entire facial soft tissues were harvested from 14 Thai soft embalmed cadavers as a facial flap specimen. Measurements of the distance, the depth, and the diameter of the facial artery were done at level of the oral commissure and the nasal ala. The distance between the facial artery and the oral commissure was 15.3 ± 3.7 mm and the depth from the skin was 11.1 ± 3.1 mm. The distance between the facial artery and the nasal ala was 6.7 ± 4.4 mm and the depth was 11.6 ± 3.7 mm. The diameters of the facial artery at level of the oral commissure and the nasal ala were 2.6 ± 0.8 and 1.9 ± 0.5 mm, respectively. Maximum risk of arterial complication from dermal filler injection lateral to the oral commissure is located approximately 15 mm at the depth of 11 mm. High risk of arterial injury at the lateral nasal ala is located at 7 mm with the depth of 12 mm.
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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: 12] [Impact Index Per Article: 1.3] [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.
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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.
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Abstract
Background Reconstruction of oropharyngeal defects after resection of oropharyngeal cancer is a significant challenge. The purpose of this study is to introduce reconstruction using a combination of a buccinator myomucosal flap and a buccal fat pad flap after cancer excision and to discuss the associated anatomy, surgical procedure, and clinical applications. Methods In our study, a combination of a buccinator myomucosal flap with a buccal fat pad flap was utilized for reconstruction after resection of oropharyngeal cancer, performed between 2013 and 2015. After oropharyngectomy, the defect with exposed vital structures was noted. A buccinator myomucosal flap was designed and elevated after an assessment of the flap pedicle. Without requiring an additional procedure, a buccal fat pad flap was easily harvested in the same field and gently pulled to obtain sufficient volume. The flaps were rotated and covered the defect. In addition, using cadaver dissections, we investigated the feasibility of transposing the flaps into the lateral oropharyngeal defect. Results The reconstruction was performed in patients with squamous cell carcinoma. The largest tumor size was 5 cm×2 cm (length×width). All donor sites were closed primarily. The flaps were completely epithelialized after four weeks, and the patients were followed up for at least six months. There were no flap failures or postoperative wound complications. All patients were without dietary restrictions, and no patient had problems related to mouth opening, swallowing, or speech. Conclusions A buccinator myomucosal flap with a buccal fat pad flap is a reliable and valuable option in the reconstruction of oropharyngeal defects after cancer resection for maintaining functionality.
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Rahpeyma A, Khajehahmadi S. Submental artery island flap in intraoral reconstruction: A review. J Craniomaxillofac Surg 2014; 42:983-9. [DOI: 10.1016/j.jcms.2014.01.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/18/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022] Open
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Soft tissue reconstruction of the oral cavity: a review of current options. Curr Opin Otolaryngol Head Neck Surg 2014; 21:311-7. [PMID: 23817293 DOI: 10.1097/moo.0b013e328362cf94] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article provides an overview of the principles of soft tissue reconstruction of the oral cavity, and reviews the recent clinical outcomes for described options. RECENT FINDINGS For small defects of the oral cavity, healing by secondary intention and primary closure are both excellent options and may provide functionally superior results. In defects where a split-thickness skin graft is appropriate, acellular dermis may provide results that are at least as good at lower cost. Free flaps, particularly the radial forearm and the anterolateral thigh, have become the mainstays of oral cavity soft tissue reconstruction for larger defects. Recent clinical series suggest that relatively novel regional flaps provide a reasonable alternative to free flap reconstructions for moderate and some large soft tissue defects. SUMMARY Soft tissue reconstruction of the oral cavity is a complex task with significant functional implications. There are a large number of reconstructive options available. Systematic appraisal of the defect and options allows the reconstructive surgeon to optimize functional potential by choosing the most appropriate reconstructive option.
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