Functional Outcomes with Facial Artery Musculo-Mucosal (FAMM) Flap and Dental Implants for Reconstruction of Floor of the Mouth and Tongue Defects in Oncologic Patients

Utility of Digastric Muscle Flap in Reconstruction of Floor of Mouth Defects

In the era of free flaps, we propose a simple yet effective local flap, the digastric muscle flap, to reconstruct floor of the mouth defects and to repair an orocervical fistula that is created during excision of tongue and/or floor of the mouth malignancies. The digastric muscle flap was used in 15 patients who were diagnosed with oral squamous cell carcinoma of the tongue and/or floor of the mouth. Partial glossectomy was performed in 4 cases, hemiglossectomy in 4 cases, and wide local excision in 7 cases. Adjuvant radiation was given in 9 patients. In all cases, the neck was addressed followed by the tumour excision. The floor of the mouth defect created while excising the tumour was repaired with the digastric muscle flap. Post-operative healing was satisfactory in all the cases. No flap failure was seen even in radiated cases. Patients were discharged by the 5th-7th day. Oral feeds were started by the 10th day. Patients were followed for 3 months to 5 years. The digastric muscle flap is an ideal flap for reconstructing small- to medium-sized floor of the mouth defects. The flap can withstand radiation. Due to the high success rate, we propose utilisation of this flap in reconstructing floor of the mouth defects and to seal orocervical fistulas.

Systematic review of minimally-invasive reconstructive options for oral cavity defects

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.

Low level of the dental health as an indicator of malignant of the oral mucosa

   Introduction. The manifestation of oncological alertness during dispensary observation by a dentist is very important. The most accessible options for preventing malignancy of the oral mucosa are sanitation, regular professional oral hygiene, as well as educational work among doctors and the population. However, despite the visual accessibility of tissues and organs of the oral cavity, there is an annual increase in malignant neoplasms in this area. In this case, most patients are diagnosed with a tumor process of the last stage. malignant neoplasms of the head and neck organs require special attention due to high risk of disability even at an early stage.

   Aim. To evaluate a correlation between malignancy of the oral mucosa and the burdened dental status of patients.

   Materials and methods. A controlled study was conducted which included 142 patients with cancer of the oral mucosa without sequential or parallel inclusion of patients in groups. Dental status was assessed at help-seeking stage or during clinical examination, as planned, by evaluation of main dental indices. The morphological diagnosis was established using histological verification.

   Results. The majority of patients with oral tumors had hard dental plaque (81.7 % of cases). The condition of the soft tissues, in addition to presence of the mucous membrane lesion, was characterized by bleeding (69 % of cases). moderate periodontal pathology was detected (19 % of cases). patients with the cavity tumors had an acute traumatic edge of hard tissues (70 % of cases), extensive caries (26 % of cases) and the presence of removable dentures (82 % of cases).

   Conclusion. The values of parameters evaluated in patients in the study with squamous cell carcinoma of the oral mucosa show its relation to aggravation of general somatic status. All patients in the study required dental treatment and training in oral hygiene care.

Reconstructing Small-Medium Sized Oral Cavity Defects- Our Experience with the Versatile Famm Flap

Background

Restoration of form and function of the oral cavity post resection for oral cavity malignancies is an enormous challenge in head and neck reconstructive surgery. The facial artery musculo-mucosal (FAMM) flap is an unexplored, underutilized yet an extremely versatile option for such defects. In this analysis we review the performance of the FAMM flap used to reconstruct tongue/floor of mouth (FOM) defects following tumor resection.

Materials and Methods

In this retrospective analysis, demographic and disease profiles of 15 patients with Tongue and Floor of Mouth carcinomas reconstructed with a FAMM flap between January 2019 to January 2021 were studied. Complications and functional outcomes were analyzed.

Results

Fifteen patients (10 men, 5 women) were reconstructed using a FAMM flap. Mean age of the study sample was 46.46 years (28-60 years). One flap was lost due to complete flap necrosis following venous congestion, two other flaps suffered distal tip necrosis. Three patients developed an Oro-cutaneous fistula, with one going on to develop a surgical site infection of the neck wound. Patients reconstructed for FOM defects had an excellent functional outcome. For patients reconstructed for a tongue defect, 33.33% of patients complained of restricted tongue mobility and 44.44% were dissatisfied with the quality of speech post operatively.

Conclusion

The versatile FAMM flap is a reliable, easy to harvest and scarless flap. It provides excellent cosmetic and functional results FAMM flap allowing early resumption of normal daily activities making it an ideal option to reconstruct small to medium sized oral cavity defects.

Reconstruction with facial artery musculo-mucosal flap (FAMM.F) after resection of upper lip pleomorphic adenoma: Case report

INTRODUCTION

Although pleomorphic adenoma (PA) is the most common neoplasm of both minor and major salivary glands, its presence in the buccal surface of upper lip is rare.

PRESENTATION OF CASE

A 70-year-old male presented with a chief complaint of recent rapid growth of a mass in the buccal aspect of the upper lip. A well-circumscribed mass measuring 3 × 2 cm with intact overlying mucosa without regional lymphadenopathy was evident. Core needle biopsy report was suggestive of PA. Complete excision of the tumor was performed. The defect was large and primary closure was not possible. Reconstruction with FAMM flap was planned. After 4 weeks, the flap was covered with epithelia and created a satisfactory result.

DISCUSSION

The definite diagnosis of PA is based on histopathological examination. The following features help to differentiate PA from other tumors; tubuloalveolar and gland-like structures, islands of cuboidal or polygonal cells in a chondroid, hyalinized, fibroadipose or mucinous hypocellular stroma which are stained positively for periodic acid-Schiff and Alcian. Despite these characteristics, differentiation of PA from dermal mixed tumor may be challenging especially when the specimen is from the upper lip. The main advantages of FAMM.F are being thin and pliable flap, having wide arc of rotation; being suitable for reconstruction of mucosal defects; resistance against postoperative radiotherapy and easy harvesting.

CONCLUSION

The FAMM flap is a reliable reconstruction technique for medium-sized intraoral defects with limited morbidity to the donor site. It provides functional reconstruction of the oral cavity with a low risk of post-operative complications.

Versatility of Facial Artery Musculomucosal (FAMM) Flap for Reconstruction of Oral Cavity Defects

Background and Purpose

The Facial Artery Musculomucosal (FAMM) flap for reconstruction of oral cavity defects is being popularized in recent years due to its obvious advantages. The aim of our study is to evaluate the cases operated at our institute for the reconstruction of oral cavity defects using FAMM flap and assess their outcomes.

Method

In this retrospective study, we included all patients in whom the FAMM flap was used to reconstruct oral cavity defects operated at our institute from January 2017 to December 2020. From the available records, patients' data like age, sex, diagnosis, treatment plan, complications, flap viability, and need for pedicle revision were retrieved and tabulated.

Results

FAMM flap was used in ten patients (8 male, 2 female) with ages ranging from 40 to 54 years. In six patients with superior defects e.g., maxilla/palate, retrograde FAMM flap was used and in the other 4 patients with inferior defects e.g., tongue/ floor of the mouth, antegrade FAMM flap was used. None of the patients developed complications like flap failure/necrosis or dehiscence. The donor site healed uneventfully in all patients.

Conclusion

FAMM flap offers various advantages for oral cavity reconstruction including mucosa reconstruction with alike mucosal tissue, muscle portion providing bulk, minimal donor site morbidity along with easier harvesting approach. There are no associated significant long-term complications if the technique is properly followed. FAMM should be considered a viable option for the reconstruction of a variety of oral cavity defects.

Assessment of Quality of Life in Head-and-Neck Oncologic Patients with Intraoral Soft-Tissue Defects Reconstructed with Buccinator Myomucosal Flap

The aim of this study is to evaluate the functional outcomes and quality of life (QoL) in oncologic patients with intraoral defects reconstructed with the buccinator myomucosal flap. A retrospective study was performed involving 39 patients with intraoral soft-tissue defects, reconstructed with a buccinator myomucosal flap during a six-year period. Patients completed the European Organization for Research and Treatment of Cancer questionnaires, the standard questionnaire (QLQ-C30) and the head-and-neck specific module (QLQ-H&N35). Thirty-nine patients with a mean age of 61.23 ± 15.80 years were included in the study. Thirty-three patients were diagnosed with an oncological condition (84.61%). Six patients (15.38%) developed orosinusal communication and underwent extensive debridement. The median global-health-status score was 79.27 and emotional performance was the lowest scoring, with a mean score of 76.93. As for the symptom items, the most outstanding were dental problems (33.33), oral opening (31.62) and dry mouth (37.61), followed by sticky saliva (24.79), problems with social eating (21.15) and pain (19.87). The most significant symptoms were radiotherapy-related adverse effects such as pain, fatigue, dental problems and dry mouth. Patients reconstructed with the buccinator myomucosal flap develop a good quality of life for all types of activities, and a correct function and aesthetics. Postoperative radiotherapy is associated with a poorer quality of life, and can lead to impairment of several symptoms such as swallowing, oral opening and dry mouth.