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Jamin C, Karam E, Marmouset F, Laure B, Moriniere S, Pare A. Tongue reconstruction after oncological resection: Analysis of the functional outcomes. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101707. [PMID: 38006946 DOI: 10.1016/j.jormas.2023.101707] [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: 10/19/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 11/27/2023]
Abstract
The curative management of oral squamous cell carcinoma can be responsible for swallowing and/or speech impairments. In this study, we analyzed the functional outcomes in patients who underwent an oncological resection and a primary reconstruction of the tongue and/or of the floor of the mouth (TFM). We also investigated the predictive factors for poor functional outcomes. This retrospective study included operated patients from October 2013 to May 2021 at the TOURS University Hospital. We assessed the functional results two years after the completion of the cancer treatment with self-administered questionnaires quantifying swallowing and speech disorders. Thirty-three patients were included and reconstructed with antebrachial free flap (N = 16), local flap (N = 8) or Biodesign ® membrane (N = 9). A higher proportion of pT1 tumor was observed in patient who had a Biodesign-based reconstruction (p = 0.001). There was no significant difference between the groups in terms of postoperative complications or for the duration of enteral feeding. The 21 patients who had an adjuvant radiation therapy had no significant more altered functions. Functional scores were significantly higher in the free flap reconstruction group (DHI =24 and SHI=21) (p = 0.008). No predictive factors for poor outcomes were observed. The repair of TFM defects must be adapted to the resection size. The reconstruction techniques allow to get acceptable functional outcomes even for the greater tumors or in case of radiation therapy. Further research would be required to better identify the predictive factors for poor outcomes.
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Affiliation(s)
- Cerise Jamin
- Department of Maxillofacial and Plastic Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France
| | - Elias Karam
- Department of Visceral Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France
| | - Franck Marmouset
- Department of Otorhinolaryngology, Tours University Hospital, 2 bd Tonnellé, Tours 37000, France
| | - Boris Laure
- Department of Maxillofacial and Plastic Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France
| | - Sylvain Moriniere
- Department of Otorhinolaryngology, Tours University Hospital, 2 bd Tonnellé, Tours 37000, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France
| | - Arnaud Pare
- Department of Maxillofacial and Plastic Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France.
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Speck NE, Haumer A, Pfister P, Muller L, Gahl B, Burger M, Largo RD, Schaefer DJ, Ismail T. Neurotized profunda artery perforator flap for subtotal tongue reconstruction - Prospective case series. J Plast Reconstr Aesthet Surg 2024; 95:35-42. [PMID: 38875869 DOI: 10.1016/j.bjps.2024.05.028] [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: 03/15/2024] [Revised: 05/05/2024] [Accepted: 05/24/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Total or subtotal glossectomy defects cause significant functional deficits in swallowing and speech and subsequently impair patients' quality of life (QOL). Recently, the profunda artery perforator (PAP) flap has emerged as a potential alternative for reconstructing extensive glossectomy defects. While previous studies assessing recovery of neurotized anterolateral thigh (ALT) flaps in head and neck reconstruction reported superior sensory recovery, improved swallow function, and improved overall patient satisfaction in patients with neurotized flaps vs. non-neurotized ALT flap reconstruction, PAP flap neurotization has not been described and systematically assessed in head and neck patients. METHODS Six patients underwent subtotal tongue reconstruction with neurotized PAP flaps at the authors' institution from May 2022 until August 2023. A branch of the posterior femoral cutaneous nerve of the PAP flap was coaptated to the lingual nerve. Two-point discrimination, Semmes-Weinstein monofilament, pain, and temperature assessments were conducted at 3, 6, and 12 months postoperatively on the neo-tongue. The MD Anderson speech and deglutition scales and the EORTC-QLQ-H&N35 were used to record functional outcomes and QOL. RESULTS The mean age was 69 ± 4 years, and the mean body mass index was 25 ± 7 kg/m2. Neo-tongue median 2-point discrimination at the tip improved from >10 mm at 3 months to 6 mm at 12 months. All patients had protective pain and temperature perception at the neo-tongue tip at the 6-month follow-up. Speech and swallowing functions were similar at the 12-month follow-up to data on neurotized ALT flaps from literature. No neuropathic pain was reported at the donor site at the 6-month follow-up. CONCLUSIONS This is the first case series of PAP flap neurotization in head and neck patients, suggesting potential functional advantages with minimal donor-site morbidity. LEVEL OF EVIDENCE V Case Series.
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Affiliation(s)
- Nicole E Speck
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
| | - Alexander Haumer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
| | - Pablo Pfister
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
| | - Laurent Muller
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Basel, Switzerland
| | - Brigitta Gahl
- Surgical Outcome Research Center, University Hospital, Basel, Switzerland
| | - Maximilian Burger
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
| | - Rene D Largo
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland; Faculty of Medicine, University of Basel, Switzerland
| | - Tarek Ismail
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland.
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Al-Aroomi MA, Al-Worafi NA, Ma Y, Alkebsi K, Mohamed AAS, Jiang C. Patient-reported outcomes after oral cancer reconstructions with radial and ulnar forearm-free flaps. Oral Dis 2024. [PMID: 38696366 DOI: 10.1111/odi.14968] [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: 01/09/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES This study aimed to evaluate patient-reported quality of life and incidence of decision regret in patients undergoing radial (RFFF) and ulnar forearm-free flaps (UFFF) reconstruction. MATERIALS AND METHODS Patients undergoing either RFFF or UFFF were assessed with the University of Washington Quality of Life (UW-QOL) and Oral Health Impact Profile (OHIP-14) questionnaires, and the Decision Regret Scale (DRS), both before and at least 12 months post-reconstruction. RESULTS In total, 40 RFFF and 40 UFFF were included. Harvesting time was longer in RFFF (p = 0.043), and the donor-site defect was significantly larger in RFFF than in UFFF (p = 0.044). Patients with UFFF scored better UW-QOL in the appearance, pain, activity, mood, and social functioning domains (p < 0.05). However, the RFFF group excelled in swallowing and chewing domains. The DRS score revealed a significant difference between RFFF and UFFF, with scores of 36.26 versus 27.36, respectively. Moreover, the mean DRS score reduced at 12 months compared with 6 months, significantly superior for UFFF. CONCLUSION Oral cancer patients reconstructed with UFFF exhibited a better appearance, social domain, and mild decision regret compared with RFFF, indicating that the UFFF may contribute to improving postoperative quality of life in oral cancer patients.
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Affiliation(s)
- Maged Ali Al-Aroomi
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China
- Faculty of Dentistry, Ibb University, Ibb, Yemen
| | | | - Yujie Ma
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China
| | | | | | - Canhua Jiang
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China
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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.
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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
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Massarelli O, Vaira LA, Crimi S, Salzano G, Latini L, Bianchi A, Gennaro P, De Riu G. Tongue Reconstruction with Buccinator Myomucosal Island Flaps: Technical Considerations, Oncologic Safety, Functional Outcomes and QoL Assessment-A Retrospective Observational Study. J Pers Med 2023; 13:879. [PMID: 37373868 DOI: 10.3390/jpm13060879] [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: 05/01/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2023] Open
Abstract
The objective of this study was to investigate the effectiveness of buccinator myomucosal island flaps for tongue reconstruction following malignant tumor resections. A retrospective study was performed on 52 patients who underwent tongue reconstructions with buccinator myomucosal island flaps between 2012 and 2020. We reviewed the flap type and size, harvesting time, recipient- and donor-site complications, postoperative oncologic outcomes, functional recovery and QoL assessment. All of the flaps were transposed successfully without any total flap loss. Neither in the primary site nor in the neck were cancer relapses observed. An evaluation of the sensitivity revealed that 96.1% of patients experienced a recovery of touch, two-point and pain sensations. There were significant differences between the flap and the native mucosa in terms of the tactile (p < 0.001), pain (p < 0.001) and two-point (p < 0.001) thresholds. The average swallowing score recorded was 6.1 out of 7, with only minor complaints. The quality of life assessments demonstrated high scores across physical (24.5 out of 28), social (25.8 out of 28), emotional (20.3 out of 24) and functional (25 out of 28) aspects. The present study showed how buccinator myomucosal island flaps represent an effective and functional tongue reconstructive option, requiring a short operative time with a low rate of donor site morbidity, and with evidence of long-term oncologic safety and high quality of life.
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Affiliation(s)
- Olindo Massarelli
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, 07100 Sassari, Italy
| | - Salvatore Crimi
- Maxillofacial Surgery Unit, University Hospital "Policlinico San Marco" of Catania, 95124 Catania, Italy
| | - Giovanni Salzano
- Maxillofacial Surgery Operative Unit, University Hospital of Naples "Federico II", 80131 Naples, Italy
| | - Linda Latini
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Alberto Bianchi
- Maxillofacial Surgery Unit, University Hospital "Policlinico San Marco" of Catania, 95124 Catania, Italy
| | - Paolo Gennaro
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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Marchiano E, Kana L, Bellile E, Smith JD, Casper KA, Malloy KM, Chinn SB, Stucken CL, Prince MEP, Chepeha DB, Rosko AJ, Spector ME. Neurotization of the radial forearm free flap improves swallowing outcomes in hemiglossectomy defects. Head Neck 2023; 45:798-805. [PMID: 36579434 DOI: 10.1002/hed.27290] [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: 08/22/2022] [Revised: 11/22/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We examined the effect of free tissue neurotization on speech and swallowing outcomes for patients undergoing reconstruction of hemiglossectomy defects with a radial forearm free flap (RFFF). METHODS A retrospective study was performed in patients with oral cavity squamous cell carcinoma undergoing a hemiglossectomy and reconstruction with a RFFF. Functional outcomes including nutritional mode, range of liquids and solids, and speech understandability were analyzed 1-year post-treatment. RESULTS Eighty-four patients were included in this analysis, 41 of whom had neurotized flaps (49%). No significant differences in demographic or clinical variables were seen between the neurotized and non-neurotized groups. On multivariate analysis controlling for BMI, flap area, and N-classification, patients with neurotized flaps were significantly more likely to have normal range of liquids and solids and less likely to have a G-tube. CONCLUSIONS Neurotization of RFFF reconstructing hemiglossectomy defects results in decreased G-tube dependence and improved range of liquids and solids.
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Affiliation(s)
- Emily Marchiano
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Lulia Kana
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Emily Bellile
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joshua D Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Keith A Casper
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Steven B Chinn
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mark E P Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Douglas B Chepeha
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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Kim YC, Lee SJ, Park H, Choi YJ, Jeong WS, Lee YS, Choi KH, Oh TS, Choi JW. Swallowing analysis in hemi-tongue reconstruction using motor-innervated free flaps: A cine-magnetic resonance imaging study. Head Neck 2023; 45:1097-1112. [PMID: 36840932 DOI: 10.1002/hed.27309] [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: 02/14/2022] [Revised: 11/06/2022] [Accepted: 01/12/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND This study aimed to explore the outcomes of motor-innervated free flaps in hemi-tongue reconstruction by assessing the tongue mobility through midsagittal images from cine-magnetic resonance imaging. METHODS In this retrospective study, 47 patients who underwent tongue reconstruction following hemi-glossectomy and 10 control subjects without any surgical history were included. Patients were classified into two groups: the motor and no-motor innervation group. Various spatial parameters related to tongue mobility that were acquired from midsagittal sections were compared during consecutive swallowing phases. RESULTS Overall, the motor group showed improved functional swallowing scale compared with the no-motor group. In case of tongue base resection, the motor group showed improved mobility of the tongue base during pharyngeal phase, whereas the no-motor group showed increased laryngeal elevation for compensatory movement. CONCLUSION The tongue reconstruction with motor-innervated free flaps may facilitate swallowing capacity in patients with a hemi-tongue defect combined with tongue base resection.
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Affiliation(s)
- Young Chul Kim
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Seok Joon Lee
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Hojin Park
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo Shik Jeong
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Yoon Se Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Suk Oh
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
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Jehn P, Gellrich NC, Moysich H, Zeller AN, Lentge F, Tavassol F, Spalthoff S, Korn P. Prelamination of the Radial Forearm Free Flap Using Free Full-Thickness Eyelid Skin Grafts: A New Approach for Intraoral Defect Reconstruction. Ann Plast Surg 2022; 89:54-58. [PMID: 35276706 DOI: 10.1097/sap.0000000000003116] [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: 11/26/2022]
Abstract
ABSTRACT Free flap transfer for reconstruction of intraoral defects is a common procedure in oral and maxillofacial surgery. For tumor-related defects, the radial forearm flap is widely used for soft tissue restoration. However, transfer of free skin grafts to the donor site region is often required for wound closure after free flap harvesting, resulting in esthetic disturbances due to shrinkage of the grafted skin, attendant scarring, or mismatches in skin texture or color. Furthermore, free flap transfer may result in hair follicle transfer into the oral cavity, causing unfavorable intraoral hair growth in adult men in particular. Free flap prelamination can help reduce the potential disadvantages of free flaps, in terms of both flap design and size and donor site morbidity. For surgical treatment of oral cancer in middle-aged and elderly patients, eyelid dermatochalasis may present as a comorbidity leading to esthetic impairments or, in cases involving the upper eyelid, even a reduced field of view. In these cases, bilateral blepharoplasty can reduce the excess eyelid skin. The present study is the first to attempt to use excised skin after bilateral blepharoplasty as full-thickness skin grafts for radial forearm free flap prelamination. This approach combined surgical therapy of eyelid dermatochalasis with free flap prelamination, thereby avoiding the need to harvest free skin grafts from other anatomically healthy regions to close the donor site defect and preventing the accompanying disadvantages. The reconstruction results and clinical outcomes of patients revealed that radial forearm free flap prelamination using bilateral free full-thickness eyelid skin grafts was an easy and feasible method for intraoral defect reconstruction. In particular, this approach could avoid intraoral hair growth and additional skin grafting from other healthy anatomical regions, yielding good esthetic and functional results at the flap's recipient and donor sites.
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Affiliation(s)
- Philipp Jehn
- From the Department for Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
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9
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Xu Q, Wang SM, Liu YH, Yin SC, Su XZ, Xu ZF. Comparison between the radial forearm and groin soft tissue free flaps for reconstruction in patients with oral cavity cancer: a quality of life analysis. Int J Oral Maxillofac Surg 2022; 51:1289-1295. [DOI: 10.1016/j.ijom.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 04/13/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
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10
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Membreno PV, Eid AA, Vanison CC, Gillespie MB, Gleysteen JP. Porcine small intestine graft for reconstruction of oral defects. Laryngoscope Investig Otolaryngol 2021; 6:940-947. [PMID: 34667835 PMCID: PMC8513448 DOI: 10.1002/lio2.626] [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: 01/23/2021] [Revised: 05/10/2021] [Accepted: 06/27/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and outcomes of porcine submucosal allograft (Biodesign Sinonasal Repair Graft [Cook Medical, Bloomington, IN]) in oral cavity and oropharynx reconstruction after ablative surgery. METHODS We conducted a prospective and retrospective review of patients who underwent Biodesign Sinonasal Repair Graft reconstruction for oral and oropharyngeal surgical defects at a single institution between 2018 and 2020. A total of 11 patients were included in the study. Data points included their perioperative medical and demographic data, immediate postoperative course, and follow-up visits at 10 days and at 2 months. The clinicopathologic characteristics of their disease, postoperative esthetic, and functional outcomes were recorded and analyzed. RESULTS Eleven procedures have been performed, and all patients received Biodesign reconstruction either immediately after ablation or after they failed a previous reconstruction. None of the patients had bone exposure. The subsites included oral tongue (n = 6), floor of the mouth (n = 3), buccal mucosa (n = 1), and soft palate (n = 1). In all cases, the operations and the postoperative course were uneventful. The mean defect size was 22 cm2. The median start of oral intake was at 2 days postoperatively. The Biodesign graft healed well in all patients with no total graft loss. There was one complication that required revision surgery due to obstruction of Wharton's duct by the Biodesign material. CONCLUSIONS Biodesign can be a viable option for small and medium-sized oral and oropharyngeal defects in patients who are medically unfit or do not want to undergo a free flap surgery. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Petra V. Membreno
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Tennessee Health and Science CenterMemphisTennesseeUSA
| | - Anas A. Eid
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Tennessee Health and Science CenterMemphisTennesseeUSA
| | - Christopher C. Vanison
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Tennessee Health and Science CenterMemphisTennesseeUSA
| | - M. Boyd Gillespie
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Tennessee Health and Science CenterMemphisTennesseeUSA
| | - John P. Gleysteen
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Tennessee Health and Science CenterMemphisTennesseeUSA
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11
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Non-Surgical Touch-Up with Hyaluronic Acid Fillers Following Facial Reconstructive Surgery. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11167507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The use of hyaluronic acid (HA) injectable fillers has become increasingly widespread in facial recontouring and rejuvenation. We report our experiences to emphasize the role of HA fillers as tools beyond aesthetic treatments in cases of post-surgical facial sequelae. HA fillers are generally used for aesthetic rejuvenation, but one potential new horizon could be their application in trauma, reconstructive, and craniofacial surgery. This study was conducted retrospectively, evaluating medical reports of patients treated at the Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, for lip incompetence, trauma, oncological, reconstructive, and craniosynostosis surgery sequelae. Visual analog scale (VAS) evaluation was performed to assess patient satisfaction. No major complications (i.e., impending necrosis or visual loss) were reported. Bruising and swelling was reported for 48 h after lip injection. At the immediate VAS evaluation, 67% of the patients were “extremely satisfied” and 33% “satisfied”. In those 33%, VAS scores changed to “extremely satisfied” at 6–9 weeks and 3–6 months of VAS evaluation (contextually to improvement in tissue flexibility, elasticity, and aesthetic appearance). Results indicate that this minimally invasive approach achieves a high level of aesthetic enhancement, improving patient satisfaction. The concept of HA filler applications could be a frontier that may be applicable to other areas of reconstructive facial plastic surgery.
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Bulbul MG, Wu M, Lin D, Emerick K, Deschler D, Richmon J, Goldsmith T, Zenga J, Puram SV, Varvares MA. Prediction of Speech, Swallowing, and Quality of Life in Oral Cavity Cancer Patients: A Pilot Study. Laryngoscope 2021; 131:2497-2504. [PMID: 33881173 DOI: 10.1002/lary.29573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/09/2021] [Accepted: 04/09/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the impact of specific treatment-related variables on functional and quality of life outcomes in oral cavity cancer (OCC) patients. STUDY DESIGN Retrospective Cohort. METHODS Patients with primary OCC at least 6 months after resection and adjuvant therapy were included. Patients completed surveys including the Speech Handicap Index (SHI), M.D. Anderson Dysphagia Inventory (MDADI), and Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN). Performance Status Scale (PSS) and tongue mobility scale were completed to allow provider-rated assessment of speech and tongue mobility, respectively. Additional details regarding treatment were also collected. These data were used to generate a predictive model using linear regression. RESULTS Fifty-three patients with oral tongue and/or floor of mouth (FOM) resection were included in our study. In multivariable analysis, greater postoperative tongue range of motion (ROM) and time since treatment improved SHI. Flap reconstruction and greater postoperative tongue ROM increased MDADI and PSS (eating and speech). A larger volume of resected tissue was inversely correlated with PSS (diet and speech). Tumor site was an important predictor of PSS (all sections). There were no statistically significant predictors of FACT-HN. CONCLUSIONS In this pilot study, we propose a battery of tools to assess function in OCC patients treated with surgery. Using the battery of tools we propose, our results show that a surgical endpoint that preserves tongue mobility and employs flap reconstruction resulted in better outcomes, whereas those with greater volume of tissue resected and FOM involvement resulted in poorer outcomes. Larger prospective studies are needed to validate our findings. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Mustafa G Bulbul
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Michael Wu
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Derrick Lin
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kevin Emerick
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniel Deschler
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeremy Richmon
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Tessa Goldsmith
- Department of Speech, language and swallowing disorders, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Joseph Zenga
- Department of Otolaryngology, Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Sidharth V Puram
- Department of Otolaryngology, Head and Neck Surgery Washington University in St Louis, St Louis, Missouri, U.S.A
| | - Mark A Varvares
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
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Akakpo KE, Varvares MA, Richmon JD, McMullen C, Holcomb AJ, Rezaee R, Tamaki A, Curry J, Old MO, Kang SY, Graboyes EM, Gross J, Pipkorn P, Puram SV, Zenga J. The tipping point in oral cavity reconstruction: A multi-institutional survey of choice between flap and non-flap reconstruction. Oral Oncol 2021; 120:105267. [PMID: 33810989 DOI: 10.1016/j.oraloncology.2021.105267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Kenneth E Akakpo
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Jeremy D Richmon
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Caitlin McMullen
- Department of Otolaryngology-Head and Neck Surgery, Moffitt Cancer Center, Tampa, FL, United States
| | - Andrew J Holcomb
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Omaha, NE, United States
| | - Rod Rezaee
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Joseph Curry
- Department of Otolaryngology-Head and Neck Surgery, Jefferson University Hospitals, Philadelphia, PA, United States
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States; Department Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Jennifer Gross
- Department of Otolaryngology-Head and Neck Surgery, Emory School of Medicine, Atlanta, GA, United States
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, United States; Department of Genetics, Washington University School of Medicine, Saint Louis, MO, United States.
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States.
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Chiang TY, Huang CH, Kuan CH, Horng SY, Hsieh JH, Wu YF, Chuang SY, Yu YH, Ho CC, Cheng NC, Tai HC. Resuming Oral Feeding in Patients With Oral Squamous Cell Carcinoma With Free Anterolateral Thigh Flap Reconstruction. Ann Plast Surg 2021; 86:S108-S112. [PMID: 33438960 DOI: 10.1097/sap.0000000000002652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Quality of life and functional improvement have emerged as important goals for patients with oncologic disease. For patients with head and neck cancer, free anterolateral thigh (ALT) flaps serve as reliable reconstruction and provide functional restoration. Nevertheless, factors affecting the resumption of oral feeding are rarely described. This study aimed to evaluate and compare the functional outcomes of oral feeding for patients with different oncologic defect patterns and reconstructive ALT flap designs. METHODS We retrospectively reviewed patients with head and neck cancer undergoing oncologic ablation and free ALT reconstruction between January 2016 and April 2018 at National Taiwan University Hospital. Patients were categorized into 2 groups as through-and-through (T&T) and non-through-and-through (non-T&T) according to the defect pattern. We further subgrouped T&T patients into lip resection/lip sparing according to lip involvement. Reconstructive ALT flaps were of 2 designs, folded (F-ALT) and chimeric (C-ALT). Outcomes of oral feeding were analyzed using descriptive statistics, and differences between groups were compared using the Student t test. RESULTS We identified 233 patients who received oncologic ablation and free ALT flap reconstruction. There was no significant difference in functional recovery between the T&T and non-T&T groups (81.2% vs 73%, P = 0.137). However, among patients who succeeded in resuming oral feeding, lip-sparing patients had better functional recovery in terms of early oral feeding within 6 months and nasogastric tube removal compared with lip-resection patients (100% vs 83.3%, P = 0.001). Moreover, the F-ALT design resulted in a higher success rate in resuming oral feeding compared with the C-ALT design (90.5% vs 54.6%, P = 0.032). CONCLUSIONS Patients with head and neck cancer with T&T defects were associated with higher rates of secondary flap revision and a trend of delayed oral feeding. In the long term, improved oral feeding outcome with the F-ALT design was observed compared with the C-ALT design in the specific group with T&T defect.
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Affiliation(s)
- Ting-Yen Chiang
- From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital
| | - Chieh-Huei Huang
- From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital
| | - Chen-Hsiang Kuan
- From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital
| | - Shyue-Yih Horng
- From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital
| | - Jung-Hsien Hsieh
- From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital
| | - Yu-Feng Wu
- From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital
| | - Shu-Yang Chuang
- From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital
| | - Ya-Han Yu
- National Taiwan University and College of Medicine, Taipei
| | | | - Nai-Chen Cheng
- From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital
| | - Hao-Chih Tai
- From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital
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Superficial Temporal Artery Perforator Flap: Indications, Surgical Outcomes, and Donor Site Morbidity. Dent J (Basel) 2020; 8:dj8040117. [PMID: 33053764 PMCID: PMC7712319 DOI: 10.3390/dj8040117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/23/2020] [Accepted: 10/09/2020] [Indexed: 01/22/2023] Open
Abstract
The aim of this retrospective case series was to discuss indications, surgical outcomes, and donor site morbidity in the use of superficial temporal artery perforator (STAP) flaps in intra-oral or extra-oral facial reconstruction. This study involved 9 patients treated with a STAP flap at the Maxillo-Facial Surgery Unit of the University of Campania “Luigi Vanvitelli”, Naples. A STAP flap was used alone or in combination with other local flaps, for the coverage of facial soft tissue defects, after the resection of craniofacial malignant tumors (n = 7) or as a salvage flap, in partial or total microvascular flap loss (n = 2). The STAP flap was proven to be a valuable surgical option despite it not being frequently used in facial soft tissue reconstruction nor was it chosen as the first surgical option in patients under 70 year’s old. Donor site morbidity is one of the major reasons why this flap is uncommon. Appropriate patient selection, surgical plan, and post-surgical touch-ups should be performed in order to reduce donor site scar morbidity.
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Chatterjee A, Laskar SG, Chaukar D. Management of early oral cavity squamous cancers. Oral Oncol 2020; 104:104627. [PMID: 32169747 DOI: 10.1016/j.oraloncology.2020.104627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 02/26/2020] [Accepted: 03/01/2020] [Indexed: 12/11/2022]
Abstract
Early oral cavity cancers comprise a favorable entity, amenable to clinical staging and single modality treatment. Surgery typically forms the mainstay of treatment and should ideally address both the primary and the neck in all cases. Careful attention must be paid to reconstruction and rehabilitation of such patients. Radical radiotherapy mainly in the form of brachytherapy can achieve excellent disease related and functional outcomes in a carefully chosen subset of patients. Increasingly, a subset of patients is being recognized, who harbor single or multiple adverse features on histopathology and may therefore benefit from escalation of adjuvant therapy. This review discusses the management of early oral cavity squamous carcinomas (Early OSCCs) in detail and highlights the dilemmas and controversies faced in the management of the same.
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Affiliation(s)
- Abhishek Chatterjee
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National University (HBNI), Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National University (HBNI), Mumbai, India.
| | - Devendra Chaukar
- Department of Head & Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National University (HBNI), Mumbai, India
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Jehn P, Zimmerer R, Dittmann J, Winterboer J, Gellrich NC, Tavassol F, Spalthoff S. Prelamination of the latissimus dorsi flap for reconstruction in head and neck surgery. Int J Oral Maxillofac Surg 2019; 48:1163-1168. [DOI: 10.1016/j.ijom.2019.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/02/2019] [Accepted: 02/13/2019] [Indexed: 11/25/2022]
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