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Sun JM, Yamamoto T. Thinned Perforator Flaps in Head and Neck Reconstruction. Oral Maxillofac Surg Clin North Am 2024; 36:537-544. [PMID: 39198073 DOI: 10.1016/j.coms.2024.07.013] [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: 09/01/2024]
Abstract
The authors aim to provide a comprehensive overview of the advancements in head and neck reconstructive surgery using thinned perforator flaps. The article categorizes these flaps based on thickness and discusses the importance of standardized terminology. Critical aspects like flap vascularity, pre-operative planning, and imaging technologies for perforator mapping are examined with practical considerations. The article then delves into various thinning techniques and their applications in head and neck reconstructions, highlighting challenges and concerns. In conclusion, significant progress in reconstructive surgery using thinned perforator flaps has brought advancements in improving surgical precision and patient outcomes in head and neck reconstructions.
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Affiliation(s)
- Jeremy Mingfa Sun
- Plastic, Reconstructive and Aesthetic Surgery Service, Department of Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
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Gazzini L, Dallari V, Fazio E, Abousiam M, Nebiaj A, Caselli A, Accorona R, Calabrese L. Functional tongue reconstruction after compartmental surgery: a schematic model for planning and insetting of the anterolateral thigh free flap. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08982-6. [PMID: 39299966 DOI: 10.1007/s00405-024-08982-6] [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: 03/30/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE Anterolateral thigh free flap (ALTFF) is a versatile option for tongue reconstruction after cancer resection. Compartmental tongue surgery (CTS) is a surgical technique whose purpose is to remove the entire oncological compartment with the pathways of tumor spread. Extended glossectomies (EG) follow the same surgical steps and anatomical concepts as CTS but extend beyond hemiglossectomy. The surgical defect following such resections often necessitates the use of a large free flap, with the ALTFF being the most commonly used. METHODS The CTS and EG are anatomically-based approaches tailored to the lesion rather than the tumor margins. Leaving a predictable defect, the reconstructive phase can, in most cases, be planned in a standardized way, assuming certain scenarios based on the surgical approach. RESULTS After CTS and EG, the residual volumetric defect is large. Therefore, the reconstructive flap of choice is the ALTFF. The ALTFF offers sufficient tissue volume to cover the functional defect and is a versatile flap. It can be harvested as a simple fasciocutaneous flap, as a chimeric flap, or as a muscle-fasciocutaneous flap, depending on the reconstruction requirements. We demonstrated the constant design of ALTFF based on the predictable defect after CTS and EG, aiming for a more precise and standardized reconstruction. CONCLUSION We propose a flap design based on the anatomy of the tongue and oral cavity after CTS or EG for a more precise and standardized reconstruction. Additionally, a standard template is particularly useful for less experienced surgeons who are approaching this technique for the first time.
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Affiliation(s)
- Luca Gazzini
- Young Confederation of European ORL-HNS, Y-CEORL- HNS, Dublin, Ireland
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Virginia Dallari
- Young Confederation of European ORL-HNS, Y-CEORL- HNS, Dublin, Ireland.
- Department of Otolaryngology Head and Neck Surgery, Santa Maria delle Croci Hospital, AUSL della Romagna, Ravenna, Italy.
| | - Enrico Fazio
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Monir Abousiam
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Aurel Nebiaj
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Arianna Caselli
- Speech and language therapy service, Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Remo Accorona
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Luca Calabrese
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
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Zirk M, Niknazemi M, Riekert M, Kreppel M, Linz C, Lentzen MP. Comparative analysis of volumetric changes between resection volume of oral tongue cancer and post operative volume of radial forearm flaps. Clin Oral Investig 2024; 28:498. [PMID: 39182195 PMCID: PMC11345318 DOI: 10.1007/s00784-024-05885-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES This study investigates the relationship between the total volume of oral tongue cancer pre-operatively and the RFFF volume post-operatively. MATERIALS AND METHODS A total of 52 DICOM imaging datasets (CT or MRI) of 26 patients were included in this study. The volume of the desired structure was quantified using semi-automatic segmentation using the software ITK-SNAP. All extracted measurements were validated by two further clinicians at separate instances. RESULTS The variation of MeanVolTu can be predicted by MeanVolFlap moderately reliable with 59.1% confidence (R-Qua: 0.591). ANOVA Testing to represent how well the regression line fits the data, resulted in the overall regression model being statistically significant in predicting the MeanVolTu (p < 0.001). The flap volume may be predicted using the following algorithm: MeanVolFlap0 = 3241,633 + 1, 322 * MeanVolTu. CONCLUSION The results of this study show positive correlation between tumor volume and flap volume, highlighting the significance of efficient flap planning with increasing tumor volume. A larger extraction volume of the radial forearm free flap from the donor site compromises the forearm more, thus increasing the probability of post-operative complications. CLINICAL RELEVANCE Radial forearm free flap design in accordance with its corresponding 3D tumor volume.
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Affiliation(s)
- Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany.
- Medical Faculty, University of Cologne, Cologne, Germany.
- Oral and Craniomaxillofacial and Plastic Surgery, MKG Köln West, Bunzlauerstr. 1, 50858, Cologne, Germany.
| | - Mina Niknazemi
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Maximilian Riekert
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Christian Linz
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Max-Philipp Lentzen
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
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Liu Y, Wu J, Liu D, Xiang D, Wu X, Wang T. The application of mixed reality technique in oromaxillo-facial reconstruction with the perforator flap for malignant tumor patients. Front Oncol 2024; 14:1437598. [PMID: 39099694 PMCID: PMC11294116 DOI: 10.3389/fonc.2024.1437598] [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: 05/24/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024] Open
Abstract
Objectives The integration of quantitative imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) with mixed reality (MR) technology holds promise for enhancing the diagnosis, prognosis, and treatment monitoring of cancer. This study compares the characteristics and effects of MR and color Doppler ultrasound (CDU) in the localization of perforator blood vessels in the lower extremities. Methods Two techniques were used to locate the perforator vessels in 40 cases of maxillofacial defect repair using perforator flaps from the lower extremities. The number of perforator vessels located in the flap area and the actual number of perforator vessels explored during the surgery were recorded. The recognition rate was calculated and the operation time and blood loss were recorded for each case. Results The recognition rates of MR technology and CDU in perforating vessels of the lower limbs were 93.9% and 97.2%, respectively (p > 0.05). The operation time was 52-74 minutes, 65-88 minutes (p > 0.05). The average bleeding volumes were 24 and 56 ml (p < 0.05), respectively. All perforator flaps were alive. One flap had a crisis and recovered after emergency exploratory treatment. Thirty donor sites of the lower extremities were directly sutured, and wounds were closed by abdominal skin grafting in 10 cases. Conclusion MR technology for successfully identifying perforator vessels can shorten the operation time, reduce the amount of bleeding in the donor site, and reduce trauma to the donor site.
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Affiliation(s)
- Yixiu Liu
- Head and Neck Surgery, Chongqing University Cancer Hospital, Chongqing, China
| | - Jian Wu
- Head and Neck Surgery, Chongqing University Cancer Hospital, Chongqing, China
| | - Daide Liu
- Department of Surgery, People’s Hospital of Shizhu, Chongqing, China
| | - Dalan Xiang
- Department of Surgery, People’s Hospital of Shizhu, Chongqing, China
| | - Xiaoyue Wu
- Head and Neck Surgery, Chongqing University Cancer Hospital, Chongqing, China
| | - Ting Wang
- Internal Medicine-Oncology, Chongqing University Cancer Hospital, Chongqing, China
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Zhang KK, Graziano FD, Cohen Z, Cunningham L, Ali B, Coleman-Belin J, Kim M, Haglich K, Cracchiolo JR, Matros E, Shahzad F, Nelson JA, Allen RJ. Clinical, functional, and patient-reported outcomes of radial forearm versus anterolateral thigh free tissue transfer for reconstruction of glossectomy defects. J Surg Oncol 2024; 129:681-690. [PMID: 38073188 DOI: 10.1002/jso.27560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/26/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND There is a lack of literature of health-related quality of life endpoints for radial forearm (RF) versus anterolateral thigh (ALT) free flap reconstruction for glossectomy defects. Our goal was to perform a comprehensive evaluation of clinical, functional, and quality of life outcomes after glossectomy reconstruction using a RF or ALT flap. METHODS A retrospective review was performed on patients who underwent glossectomy and immediate reconstruction with RF or ALT flaps between 2016 and 2021. Outcomes of interest included readmission and reoperation rates, functional assessments, tracheostomy and gastrostomy tube status, and FACE-Q Head and Neck Cancer scores. RESULTS Seventy-eight patients consisting of 54 RF and 24 ALT free flaps were included. ALT patients had a larger median flap size (72 vs. 48 cm2 , p = 0.021) and underwent mandibulotomy (50% vs. 7.4%, p < 0.0001) and base of tongue resection (58.3% vs. 24.1%, p = 0.005) at higher rates. No significant differences were found with respect to other outcomes. CONCLUSION The RF and ALT flaps are suitable for glossectomy reconstruction, with minimal differences seen in postoperative outcomes. Our study suggests that ALT can be used in patients with base of tongue and larger defect sizes, while providing similar functional and clinical outcomes to RF reconstruction.
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Affiliation(s)
- Kevin K Zhang
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Francis D Graziano
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Zack Cohen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Louise Cunningham
- Speech Pathology, Center for Speech and Hearing, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Barkat Ali
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Janet Coleman-Belin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kathryn Haglich
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer R Cracchiolo
- Head and Neck Oncology Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Farooq Shahzad
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert J Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Karimi E, Hashemi Z, Sohrabpour S, Mousavi SMM, Yousefi J. Comparison of swallowing disorder in patients with tongue cancer undergoing reconstruction with either a radial forearm free flap or a submental island flap. Oral Maxillofac Surg 2024; 28:125-130. [PMID: 36629975 DOI: 10.1007/s10006-023-01137-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE In this study, the swallowing status of patients with tongue cancer undergone tongue reconstruction using radial forearm free flaps (RFFF) and submental flaps were compared. METHODS A total of 26 patients with tongue cancer undergone tongue resection were randomly treated by tongue reconstruction with either submental flap or RFFF approach. Swallowing status of the patients was investigated using fiberoptic endoscopic evaluation of swallowing (FEES) by measurement of pharyngeal residue and penetration scales. RESULTS The pharyngeal residue scale in vallecula and pyriform sinus and the average of vallecula and pyriform sinus on days 10 and 30 post-operation as well as penetration scale at the same time showed no significant difference between two groups. However, the time to start oral feeding was significantly reduced in the submental group compared to the free flap group (P = 0.031). A positive Pearson correlation was found between the size of oral tongue and base of tongue resection and some of swallowing parameters. CONCLUSION Since there was no significant difference between submental and free flap respected to swallowing disorder, the submental flap is prior to free flap due to lower cost and hospitalization and less complication after tongue reconstruction.
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Affiliation(s)
- Ebrahim Karimi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahrasadat Hashemi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Otorhinolaryngology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
| | - Saeed Sohrabpour
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Mostafa Modarres Mousavi
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran.
- Department of Nanobiotechnology, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Jaleh Yousefi
- Department of Otolaryngology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Clegg DJ, Deek AJ, Salomon BJ, Blackburn C, Fahmy MD, Heidel RE, Stephenson SM, Herbig KS, Chun JT, Carlson ER, Boukovalas S. Mandible Reconstruction in a Rural Population: Comparison of Radial Forearm and Free Fibula Flap Outcomes. J Craniofac Surg 2024; 35:119-124. [PMID: 37938094 DOI: 10.1097/scs.0000000000009832] [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: 05/16/2023] [Accepted: 09/14/2023] [Indexed: 11/09/2023] Open
Abstract
Comparison of microsurgical reconstructive options after mandible resection is limited in the literature. Fibula free flaps (FFFs) can be costly and have timing limitations, but dental restoration can be performed, with varied reported rates of completion. The radial forearm free flap (RFFF) with mandible plating may be an alternative in select populations. The purpose of this study was to determine if the RFFF has similar outcomes to the FFF for mandible reconstruction in a rural population. A retrospective review of patients who underwent mandibulectomy from 2017 to 2021 at a single tertiary-care academic institution was performed. Those with FFF or RFFF reconstruction were included. Mandible defects were classified using the Jewer-Boyd H-C-L system. Sixty-eight patients were included with 53 undergoing FFF and 15 undergoing RFFF. Immediate reconstruction was significantly more common with RFFF than FFF (100% versus 64.2%; P =0.01). Lateral mandible defects were most common among both groups (52.9% FFF versus 73.3% RFFF; P =0.04). Osseous defect length was similar (9.5 cm FFF versus 7.7 cm RFFF; P =0.07), but soft tissue defect size was significantly larger in the RFFF group (28.6 cm 2 versus 15.3 cm 2 ; P =0.01). Complication rates (47.1% FFF versus 46.7% RFFF; P =0.98) and disease-free status at last follow-up (96.2% FFF versus 80.0% RFFF; P =0.06) were similar. Dental restoration occurred in 21.3% of patients undergoing FFF. Patients undergoing RFFF or FFF reconstruction after mandibulectomy had similar surgical and disease outcomes, with a low rate of completed dental restoration after FFF. Our findings suggest RFFF is a reasonable alternative to FFF for mandible reconstruction in select patients.
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Affiliation(s)
- Devin J Clegg
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville TN
| | - Andrew J Deek
- Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Brett J Salomon
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville TN
| | - Caleb Blackburn
- Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Mina D Fahmy
- Department of Oral & Maxillofacial Surgery, New Hampshire Oral and Maxillofacial Surgery, Pembroke, NH
- Department of Oral & Maxillofacial Surgery, Elliot Hospital, Manchester, NH
| | - Robert E Heidel
- Department of Surgery, Division of Biostatistics, University of Tennessee Graduate School of Medicine
| | - Stacy M Stephenson
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Kathleen S Herbig
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Joseph T Chun
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Eric R Carlson
- Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Stefanos Boukovalas
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
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Saito M, Nakane A, Asaumi R, Kagifuku Y, Ishii M, Hasegawa S, Yoshimi K, Yamaguchi K, Nakagawa K, Hirai H, Kuroshima T, Tomioka H, Tohara H. Free-flap volume correlates with body mass index in patients with tongue squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2023; 8:1210-1216. [PMID: 37899853 PMCID: PMC10601574 DOI: 10.1002/lio2.1131] [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: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives This study aimed to investigate the relationship between postoperative reconstructed tongue flap volume (RTFV) and body mass index (BMI) and identify factors affecting the flap volume in patients with tongue squamous cell carcinoma. Methods Thirty-two patients were evaluated for RTFV from computed tomography images and BMI. The first and second evaluations were done at 6 months and 1.5 years after surgery respectively. RTFV rate changes and BMI differences from the first and second evaluations were calculated. The correlation between RTFV rate change and BMI difference was assessed using Spearman's rank correlation coefficient. Multiple regression analysis evaluated the relationship between the flap volume rate change and age, sex, flap type, and BMI difference to identify influencing factors. Results The flap volume rate change and BMI difference correlated significantly (r = .594, p < .05). BMI difference and flap type were independent factors that affected reconstructed flap volume rate change in multiple regression analysis (p < .05). Conclusion The flap volume of patients with tongue squamous cell carcinoma correlates with the BMI change in the chronic phase. Patients after tongue reconstruction need to be well nourished to maintain BMI and thus postoperative tongue volume to maintain the quality of life. Level of Evidence Level 3.
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Affiliation(s)
- Mitsuko Saito
- Division of Gerontology and GerodontologyDepartment of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityTokyoJapan
| | - Ayako Nakane
- Division of Gerontology and GerodontologyDepartment of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityTokyoJapan
- Dentistry & Oral SurgeryJapan Community Health‐Care Organization Tokyo Shinjuku Medical CenterTokyoJapan
| | - Rieko Asaumi
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at TokyoThe Nippon Dental UniversityTokyoJapan
| | - Yuko Kagifuku
- Division of Gerontology and GerodontologyDepartment of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityTokyoJapan
| | - Miki Ishii
- Division of Gerontology and GerodontologyDepartment of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityTokyoJapan
| | - Shohei Hasegawa
- Division of Gerontology and GerodontologyDepartment of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityTokyoJapan
| | - Kanako Yoshimi
- Division of Gerontology and GerodontologyDepartment of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityTokyoJapan
| | - Kohei Yamaguchi
- Division of Gerontology and GerodontologyDepartment of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityTokyoJapan
| | - Kazuharu Nakagawa
- Division of Gerontology and GerodontologyDepartment of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityTokyoJapan
| | - Hideaki Hirai
- Division of Oral Health Sciences, Department of Oral and Maxillofacial Surgical Oncology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry & Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
| | - Takeshi Kuroshima
- Division of Oral Health Sciences, Department of Oral and Maxillofacial Surgical Oncology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Hirofumi Tomioka
- Division of Oral Health Sciences, Department of Oral and Maxillofacial Surgical Oncology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Haruka Tohara
- Division of Gerontology and GerodontologyDepartment of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityTokyoJapan
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Alhindi N, Mortada H, Alsubhi AH, Alhamed L, Aljahdali FH, Aljindan F. Quality of life in post-tongue reconstruction: a comprehensive systematic review and meta-analysis of radial free forearm flap versus anterolateral thigh flap. EUROPEAN JOURNAL OF PLASTIC SURGERY 2023. [DOI: 10.1007/s00238-023-02066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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10
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Gazzini L, Fazio E, Dallari V, Spirito L, Abousiam M, Nocini R, Nebiaj A, Giorgetti G, Calabrese L. Beyond the boundaries of compartmental hemiglossectomy: a proposal for an anatomically based classification of surgical approaches to advanced oral tongue squamous cell carcinoma. Eur Arch Otorhinolaryngol 2023; 280:3015-3022. [PMID: 36897364 DOI: 10.1007/s00405-023-07915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/04/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION In the last decade, compartmental surgery (CTS) has been the surgical approach of choice for advanced tumors of the tongue and oral floor. METHODS Advanced tumors (cT3-T4) oral tongue squamous cell carcinoma (OTSCC) may extend beyond the lingual septum and involve the contralateral hemitongue, developing along the intrinsic transverse muscle. The disease may then involve the genioglossus muscle and, more laterally, the hyoglossus muscle. RESULTS The surgical approach to the contralateral tongue must be guided by anatomic and anatomopathological principles to achieve a safe oncological resection based on the principles of CTS. CONCLUSION We propose a schematic classification of glossectomies that extend to the contralateral hemitongue based on the anatomy and pathways of tumor spread.
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Affiliation(s)
- Luca Gazzini
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Enrico Fazio
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Virginia Dallari
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy.
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Luca Spirito
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Varese Insubria, Varese, Italy
| | - Monir Abousiam
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Riccardo Nocini
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy
| | - Aurel Nebiaj
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Giovanni Giorgetti
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Luca Calabrese
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
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Watarai A, Yasunaga Y, Nakao J, Mori H, Araki J, Ishii Y, Yonezawa M, Kakinuma S, Mukaigawa T, Kadomatsu K. Groin and anterolateral thigh flaps for hemiglossectomy reconstruction: A comparison based on Japanese speech intelligibility. Auris Nasus Larynx 2023; 50:110-118. [PMID: 35597697 DOI: 10.1016/j.anl.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The differences in speech function between groin flap reconstruction and anterolateral thigh (ALT) flap reconstruction after hemiglossectomy have not been clarified to date. This study aimed to compare Japanese speech intelligibility after hemiglossectomy reconstruction using groin and ALT flaps of similar thickness. METHODS Data of patients who underwent hemiglossectomy reconstruction with groin or ALT flaps between April 2010 and March 2020 were collected from the medical chart database. The ALT flap was the first choice for hemiglossectomy reconstruction, and a groin flap was used when the ALT flap was >10 mm. Cases in which speech intelligibility assessments based on Hirose's 10-point scoring system, the TKR speech test, and the Japanese speech intelligibility test for 100 monosyllables were performed after 6 months postoperatively were extracted. The per-patient scores for each assessment were initially compared between the two flap groups. Then, the results of the Japanese speech intelligibility test for 100 monosyllables were reanalyzed on a syllable-by-syllable basis. RESULTS Among the 44 hemiglossectomy patients who underwent free-flap reconstruction during the study period, 14 (seven each in the groin flap and ALT flap groups) underwent all three conventional speech intelligibility assessments after 6 months postoperatively. The two groups showed no significant difference in postoperative speech intelligibility in any of the three patient assessment methods. However, in intergroup comparisons based on per-syllable accuracy for each of the 100 monosyllables, the groin flap group showed 19 syllables with a significantly higher accuracy, whereas the ALT flap group showed one such syllable. In particular, five out of the six alveolar consonants (/t/ and /d/) were more accurately articulated in the groin flap group. Per-syllable accuracy was significantly higher in the groin flap group (74.6% vs. 66.7%; 95% confidence interval: 4.6-11.1, p < 0.001). CONCLUSION In patients undergoing hemiglossectomy reconstruction, our new analysis method, which compared intelligibility by syllables, showed that the groin flap yielded higher speech intelligibility than the ALT flap. This difference was evident at all four articulation points involving the tongue, whereas there was no significant difference at the two articulation points without tongue involvement.
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Affiliation(s)
- Aya Watarai
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan; Department of Plastic and Reconstructive Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Yoshichika Yasunaga
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan.
| | - Junichi Nakao
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Hiroaki Mori
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Jun Araki
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Yoshitaka Ishii
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Minami Yonezawa
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Shota Kakinuma
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Takashi Mukaigawa
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Koichi Kadomatsu
- Department of Plastic and Reconstructive Surgery, Showa University School of Medicine, Tokyo, Japan
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12
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Papanikolas MJ, Hurrell MJL, Clark JR, Low THH, Ch'ng S, Elliott MS, Palme CE, Wykes J. Anterolateral thigh, radial forearm and superficial circumflex iliac perforator flaps in oral reconstruction: a comparative analysis. ANZ J Surg 2023; 93:1335-1340. [PMID: 36629132 DOI: 10.1111/ans.18239] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Anterolateral thigh (ALT) and Radial forearm free flaps (RFFF) are historically the most common methods of oral reconstruction. The Superficial circumflex iliac artery perforator flap (SCIP) is an alternative providing a donor site that can be readily closed primarily with improved cosmesis in younger patients, due to its concealability. METHODS We reviewed 135 patients who received ALT, RFFF or SCIP flaps for oral reconstruction in our institution. Our aim was to compare operative and perioperative outcomes between each cohort. ANOVA and χ2 test were used for statistical analysis. RESULTS There were 37 ALT, 64 RFFF and 35 SCIP reconstructions. Patients reconstructed with SCIP flaps had smaller resection volumes (P < 0.001) and earlier T and N classifications (P = 0.001, P = 0.008), and consequently reduced tracheostomy rates (P < 0.001), reduced need for enteral feeding at discharge (P < 0.001) and shorter length of stay and perioperative times (P < 0.001). SCIP flaps were more common in younger patients (P < 0.01). ALT flaps were used for more advanced disease (P = 0.001) and had larger resection volumes (P < 0.001) and increased need for assisted enteral feeding (P < 0.001). There were no significant differences in flap or donor site outcomes. There were two flap failures, both RFFF. CONCLUSION Each flap plays an important role in the reconstruction of oral defects, with larger defects preferentially reconstructed with ALT flaps. SCIP appears to be a reliable alternative in small defects with excellent perioperative and postoperative outcomes.
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Affiliation(s)
- Michael John Papanikolas
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Michael James Leslie Hurrell
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael S Elliott
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - James Wykes
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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13
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Ranganath K, Jalisi SM, Naples JG, Gomez ED. Comparing outcomes of radial forearm free flaps and anterolateral thigh free flaps in oral cavity reconstruction: A systematic review and meta-analysis. Oral Oncol 2022; 135:106214. [DOI: 10.1016/j.oraloncology.2022.106214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
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14
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Choi JW, Alshomer F, Kim YC. Current status and evolution of microsurgical tongue reconstructions, part I. Arch Craniofac Surg 2022; 23:139-151. [PMID: 36068689 PMCID: PMC9449093 DOI: 10.7181/acfs.2022.00654] [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: 05/10/2022] [Revised: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Reconstructive surgery in the management of head and neck cancer has evolved to include structure-specific approaches in which organ-specific treatment algorithms help optimize outcomes. Tongue cancer management and reconstruction are surgical challenges for which well-executed reconstructive plans should be completed promptly to avoid delaying any subsequently planned oncologic treatment. Crucial considerations in tongue cancer resection are the significant functional morbidity associated with surgical defects, particularly in terms of speech and swallowing, and the consequent negative impact on patients' quality of life. With the evolution of microsurgical techniques and the development of the perforator flap concept, flap options can be tailored to the characteristics of various tongue defects. This has allowed the implementation of pliable flaps that can help restore tongue mobility and yield subsequent functional outcomes. Using an evolutional framework, we present this series of reviews related to tongue reconstruction. The first part of the review summarizes flap options and flap-related factors, such as volume and tissue characteristics. Related functional aspects are also presented, including tongue mobility, speech, and swallowing, as well as ways to evaluate and optimize these outcomes.
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Affiliation(s)
- Jong-Woo Choi
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Feras Alshomer
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Chul Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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15
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Fang Y, Ouyang Q, Zheng Z, Wang J. Case Report: Superficial Circumflex Iliac Artery Perforator Flap for Tongue Reconstruction Following the Hemiglossectomy. Front Surg 2021; 8:692331. [PMID: 34805255 PMCID: PMC8599122 DOI: 10.3389/fsurg.2021.692331] [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: 04/08/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Therapeutic evaluation of applying superficial circumflex iliac artery perforator (SCIP) flap in tongue reconstruction after hemiglossectomy. Methods: We retrospectively collected a total number of 14 patients who received SCIP flap reconstruction for tongue defects at the Fujian Medical University affiliated Union Hospital, between November 2016 and November 2020. We evaluated the clinical features of the flap, analyzed the postoperative functions and esthetic effects after 6 months of the tongue reconstruction. Results: All the SCIP flaps survived successfully after the operation, the recipient site tongue bodies were well reconstructed 6 months after the surgery. Patient speech and swallowing functions were well recovered during the follow-up. The scars in the donor site were concealed with limited numbness. Conclusions: With the advantages of the hidden donor site and aesthetic benefits, the SCIP flap is a reliable option for the reconstruction of the tongue defect after hemiglossectomy.
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Affiliation(s)
- Yihong Fang
- Department of Oral Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qiming Ouyang
- Department of Oral Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhi Zheng
- Department of Oral Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jin Wang
- Department of Oral Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
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16
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MacDonald A, Gross A, Jones B, Dhar M. Muscle Regeneration of the Tongue: A review of current clinical and regenerative research strategies. TISSUE ENGINEERING PART B-REVIEWS 2021; 28:1022-1034. [PMID: 34693743 DOI: 10.1089/ten.teb.2021.0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Various abnormalities of the tongue, including cancers, commonly require surgical removal to sequester growth and metastasis. However, even minor resections can affect functional outcomes such as speech and swallowing, thereby reducing quality of life. Surgical resections alone create volumetric muscle loss whereby muscle tissue cannot self-regenerate within the tongue. In these cases, the tongue is reconstructed typically in the form of autologous skin flaps. However, flap reconstruction has many limitations and unfortunately is the primary option for oral and reconstructive surgeons to treat tongue defects. The alternative, but yet undeveloped strategy for tongue reconstruction is regenerative medicine, which widely focuses on building new organs with stem cells. Regenerative medicine has successfully treated many tissues, but research has inadequately addressed the tongue as a vital organ in need of tissue engineering. In this review, we address the current standard for tongue reconstruction, the cellular mechanisms of muscle cell development, and the stem cell studies that have attempted muscle engineering within the tongue. Until now, no review has focused on engineering the tongue with regenerative medicine, which could guide innovative strategies for tongue reconstruction.
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Affiliation(s)
- Amber MacDonald
- The University of Tennessee Knoxville College of Veterinary Medicine, 70737, Large Animal Clinical Sciences, 2407 River Drive, Knoxville, Tennessee, United States, 37996-4539;
| | - Andrew Gross
- The University of Tennessee Medical Center, 21823, Knoxville, Tennessee, United States;
| | - Brady Jones
- The University of Tennessee Medical Center, 21823, Knoxville, Tennessee, United States;
| | - Madhu Dhar
- University of Tennessee Knoxville College of Veterinary Medicine, 70737, Large Animal Clinical Sciences, College of Veterinary Medicine, 2407 River Drive, Knoxville, Tennessee, United States, 37996.,University of Tennessee;
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17
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Comparison of Donor Site Morbidity Between Anterolateral Thigh and Radial Forearm Free Flaps for Head and Neck Reconstruction: A Systematic Review and Meta-Analysis. J Craniofac Surg 2021; 32:1706-1711. [PMID: 33405443 DOI: 10.1097/scs.0000000000007381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ABSTRACT This meta-analysis aimed to provide an up-to-date comparison of donor site morbidity (DSM) between patients who underwent head and neck reconstruction with Anterolateral thigh (ALT) and radial forearm free (RFF) flaps. We searched the PubMed, Web of Science, EMBASE, and Cochrane Library databases to identify studies that compared DSM between ALT and RFF patients. Study quality was assessed using the Newcastle-Ottawa Scale. The pooled odds ratio (OR) of each DSM between ALT and RFF patients was estimated using a random- or fixed-effect model depending on the degree of interstudy heterogeneity. Sensitivity and subgroup analyses were performed if substantial heterogeneity was detected. Eighteen cohort studies with 1,018 patients (535 ALT and 483 RFF patients) were included. Compared with RFF, ALT were associated with lower risks of wound dehiscence (OR = 0.2, 95%CI: 0.10-0.42, P < 0.01), strength impairment (OR = 0.18, 95%CI: 0.07-0.47, P < 0.01), and movement impairment (OR = 0.19, 95%CI:0.07-0.49, P < 0.01). A subgroup analysis showed that ALT were associated with a lower risk of donor site numbness among patients undergoing tongue reconstruction (OR = 0.05, 95%CI: 0.01-0.25, P < 0.01), but not among all patients undergoing head and neck reconstruction. The pooled ORs of other DSMs demonstrated no significant difference between ALT and RFF patients. ALT are superior to RFF for head and neck reconstruction in terms of donor site wound dehiscence, strength impairment, movement impairment, and for tongue reconstruction specifically in terms of donor site numbness. No significant differences in the incidence of donor site hematoma/seroma, infection, or dissatisfaction with donor site appearance were identified between ALT and RFF patients.
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18
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Yamazaki M, Suzuki T, Hiraga C, Yoshida Y, Baba A, Saitou H, Ogane S, Fujii T, Takano M, Katakura A, Tanaka I, Nomura T, Takano N. Effect of postoperative radiotherapy for free flap volume changing after tongue reconstruction. Oral Radiol 2021; 37:518-523. [PMID: 33184774 DOI: 10.1007/s11282-020-00489-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of postoperative radiotherapy (RT) on temporal volume changes with a cutaneous free flap (CF) and a myocutaneous free flap (MCF). METHODS The subjects were 24 men and 11 women (mean age, 50.5 ± 15.5 years) with tongue or floor of mouth cancer. Twenty-seven cases of CF and eight cases of MCF were selected. The flap volume change of the reconstructed tongue was calculated using computed tomography (CT) images taken immediately and at one year postoperatively using the DICOM image processing software OsiriX®. RESULTS The reduction rate in flap volume at one year postoperatively was 82.0 ± 15% in CF without RT, 70.3 ± 26.1% in CF with RT, 88.5 ± 14.7% in MCF without RT, and 99.5 ± 16% in MCF with RT. The MCF volume was significantly higher compared to the CF volume. Although postoperative RT reduced the CF volume by 30%, there was only a slight reduction in the MCF volume. CONCLUSIONS We evaluated the effect of postoperative RT on volume reduction in 35 cases of the reconstructed tongue with CF and MCF using a computer-assisted volume rendering technique. In this study, the effect of RT on volume reduction was different between the CF and MCF.
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Affiliation(s)
- Masae Yamazaki
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Taiki Suzuki
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan.
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan.
| | - Chiho Hiraga
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Yoshifumi Yoshida
- Department of Oral Medicine, Hospital Dentistry, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Akira Baba
- Department of Radiology, The Jikei University School of Medicine and University Hospital, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 1058461, Japan
| | - Hirokazu Saitou
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Satoru Ogane
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Takako Fujii
- Department of Plastic Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Masayuki Takano
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2-9-18, Kanda-Misakicho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Akira Katakura
- Department of Oral Pathological Science and Surgery, Tokyo Dental College, 2-9-18, Kanda-Misakicho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Ichiro Tanaka
- Department of Plastic Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Takeshi Nomura
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Nobuo Takano
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
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19
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Bera RN, Tiwari P. Do medial sural artery perforator flaps have better clinical outcomes compared to the rectus abdominis perforator (DIEAP) flap in reconstruction of glossectomy defects? A Prisma guided meta-analysis. Ann Maxillofac Surg 2021; 11:121-128. [PMID: 34522666 PMCID: PMC8407617 DOI: 10.4103/ams.ams_339_20] [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: 08/30/2020] [Revised: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND There is an increasing evidence for the use of thin flaps based on vascular perforators for reconstructive surgeries. The medial sural and deep inferior epigastric artery flaps offer versatility for the reconstruction of major defects of the head and neck. OBJECTIVES "Whether medial sural artery perforator (MSAP) flap or rectus abdominis perforator flap is better for the reconstruction of glossectomy defects in terms of functional outcome?" DATA SOURCES PubMed, Cochrane Library, clinicaltrials.gov and hand searches. PARTICIPANTS AND INTERVENTIONS Patients who underwent tongue reconstruction with either MSAP flap or deep inferior epigastric artery perforator (DIEAP) flap. STUDY APPRAISAL AND SYNTHESIS METHODS Based on defined study criteria 6 studies were selected according to Prisma Guidelines. The overall estimated effect was categorized as significant where P < 0.05. RESULTS There was no significant difference between both flaps in terms of receptor site complications (P = 0.223). Overall odds ratio (OR) for complications was 1.35 (95% confidence interval [CI]: 0.412-0.736) and the test for overall effect t value was 2.836, P < 0.05. Overall OR was 6.01 (95% CI 0.5-7.45) and the test for overall effect t value was 1.41, P < 0.05 indicating there was a statistical difference in the intelligibility of speech. LIMITATIONS Anatomical variations, under-reporting of studies and lack of universal tool for speech intelligibility. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Both the flaps are comparable in terms of functional outcome. Medium-sized defects can be reconstructed with MSAP and composite larger defects would benefit from DIEAP. In females, anterolateral thigh flap still remains the choice for composite reconstructions.
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Affiliation(s)
- Rathindra Nath Bera
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences Trauma Centre BHU, Varanasi, Uttar Pradesh, India
| | - Preeti Tiwari
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences Trauma Centre BHU, Varanasi, Uttar Pradesh, India
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De Santis G, Mattioli F, Pinelli M, Martone A, Starnoni M, Fermi M, Presutti L. Tip of the Tongue Reconstruction with Prelaminated Fasciomucosal Radial Forearm Free Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3226. [PMID: 33425574 PMCID: PMC7787281 DOI: 10.1097/gox.0000000000003226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Abstract
Tongue cancer is the most common malignant neoplasm of the oral cavity. Occurrence in the tip of the tongue (TOT) is rare. We describe a case report of a TOT tumor excision and reconstruction with a prelaminated fasciomucosal radial forearm free flap. A 41-year-old white man was referred to our department for a squamous cell carcinoma of the tip of the tongue. The patient worked as an air traffic control official; therefore, conservation of speech intelligibility, both in Italian and English language, was of paramount importance. A transoral excision of TOT, bilateral selective neck dissection, and reconstruction with prelaminated fasciomucosal radial forearm free flap were performed. Adjuvant radiotherapy was necessary. The patient was completely re-established as an air traffic control officer. Successful tongue reconstruction of smaller defects depends on thinness, pliability of flap, and conservation of tongue mobility. Surgical options for TOT reconstruction are facial artery muscolomucosa flap, Zhao flap, radial forearm free flap, or primary suture. In the authors' opinion, a fasciomucosal prelaminated RFFF offers a series of advantages for TOT reconstruction. The absence of subcutaneous tissue makes the PFRFFF much thinner than fascio-cutaneous flaps. Compared with mucosal loco-regional flaps, prelaminated flaps allow the preservation of oral mucosa lining while providing adequate bulk and reduced scar formation for optimal func- tional recovery. In our case report, the fasciomucosal flap allowed an adequate reconstruction of TOT volume with good functional and aesthetic outcomes. The flap's added bulk and its minimal scar retraction granted free tongue movement and optimal speech intelligibility.
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Affiliation(s)
- Giorgio De Santis
- From the Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
| | - Francesco Mattioli
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
| | - Massimo Pinelli
- From the Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
| | - Andrea Martone
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
| | - Marta Starnoni
- From the Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
| | - Matteo Fermi
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
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21
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Tamer R, Chen Y, Xu X, Xie C, Swai J. Short-Term Quality of Life, Functional Status, and Their Predictors in Tongue Cancer Patients After Anterolateral Thigh Free Flap Reconstruction: A Single-Center, Prospective, Comparative Study. Cancer Manag Res 2020; 12:11663-11673. [PMID: 33235497 PMCID: PMC7678467 DOI: 10.2147/cmar.s268912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the quality of life, functional status, and their predictors in tongue cancer patients up to three months after anterolateral thigh free flap (ALTFF) reconstruction. Patients and Methods Tongue cancer patients were examined before and one and three months after ALTFF reconstruction using three validated questionnaires: the MD Anderson Dysphagia Inventory (MDADI), Eating Assessment Tool (EAT-10), and Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N). Mean scores were compared using the Friedman test. Forward selection and backward elimination methods of multiple linear regression analysis were used to identify the predictors of quality of life and functional status using SPSS at a 95% significance level. Results The present study included 265 participants (88.68% males, mean age 46.7 ± 11.05 years). The mean MDADI and EAT-10 scores were highest at one month after the surgery and lowest at three months after the surgery (p < 0.05). The mean FACT-H&N score was lowest at one month after the surgery (p < 0.05); however, post hoc analysis revealed that the difference in the scores before and three months after the surgery was non significant (p > 0.05). Denture use, occupation, age, tumor site, illness duration, drinking habit, and diet predicted the patients' quality of life, while denture use, betel nut consumption, age, marital status, and diet predicted their functional status. Conclusion Although tongue cancer patients have a poor quality of life and functional status in the first month after ALTFF reconstruction, their quality of life and functional status improve thereafter. We recommend the implementation of swallowing training programs and case-oriented psychological interventions to assist patients in coping with temporary deterioration during the first month after the surgery.
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Affiliation(s)
- Roba Tamer
- Xiangya School of Nursing, Central South University, Changsha City, Hunan Province, People's Republic of China.,Department of Nursing, Hama University, Hama City, Syria
| | - Yongyi Chen
- Xiangya School of Nursing, Central South University, Changsha City, Hunan Province, People's Republic of China.,Department of Hospital Administration, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha City, Hunan Province, People's Republic of China
| | - Xianghua Xu
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha City, Hunan Province, People's Republic of China
| | - Chanjuan Xie
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha City, Hunan Province, People's Republic of China
| | - Joel Swai
- Department of Nephrology and Rheumatology, The Third Xiangya Hospital of Central South University, Changsha City, Hunan Province, People's Republic of China
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22
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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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23
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Wang D, Gao T, Liu L, Chen Y, Liao S, Xu T, Zhang K. Thin superficial inferior epigastric artery perforator flap for reconstruction of the tongue. Br J Oral Maxillofac Surg 2020; 58:992-996. [PMID: 32591211 DOI: 10.1016/j.bjoms.2020.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/11/2020] [Indexed: 02/08/2023]
Abstract
The superficial inferior epigastric artery (SIEA) flap is widely used in the repair of large soft tissue defects of the extremities and in breast reconstruction. Because of the high fat content of the abdomen, it has been less used for glossectomy reconstruction. Here we present a series of seven patients who each underwent reconstruction with a thin SIEA flap after resection of the tongue. There were six men and one woman (mean age 48, range 24-66 years). All patients underwent preoperative computed tomographic (CT) angiography, and colour Doppler ultrasound (US) was used to select and map the most suitable SIEA. The flap was raised above the Scarpa's layer while adjusted the plane of dissection according to the specific needs for bulk in each case. All the flaps survived; one flap required a secondary anastomosis because of a venous anastomotic embolus. The size of flap used was 5.0cm×6.0cm - 7.0cm×9.0cm, and the flap was 0.8cm-1.4cm thick. The functional outcome was evaluated at 6 - 18 months follow up, when speech and swallowing were both good in all cases. The dissection above the pubic symphysis is an important refinement of the SIEA flap, and we conclude that the thin SIEA flap is a good choice for reconstruction after excision of cancer of the tongue.
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Affiliation(s)
- D Wang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - T Gao
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - L Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Y Chen
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - S Liao
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - T Xu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - K Zhang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China.
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