1
|
Dang RR, El Abbadi S, Tsao CK. Commissuroplasty using the triangular cheek flap in patients with free flap reconstruction of through and through buccal defects. Head Neck 2023; 45:1868-1870. [PMID: 37283147 DOI: 10.1002/hed.27386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/13/2023] [Indexed: 06/08/2023] Open
Abstract
Extensive resections of advanced stage oral cavity cancers can sometimes lead to significant through and through buccal defects with compromise of the oral commissure/lips. Post free flap reconstruction, such patients often require a secondary delayed commissuroplasty to assist with improved oral function and quality of life. In current literature, limited methods exist for free flap commissuroplasty with some key limitations, particularly their negative impact on buccal sulcus or oral vestibule. Our technique of the triangular cheek flap commissuroplasty allows the surgeon to reconstruct a neo-commissure without compromising the oral vestibular depth or decreasing mouth opening. Through this pictorial essay we describe a detailed surgical technique for secondary reconstruction of the oral commissure.
Collapse
Affiliation(s)
- Rushil R Dang
- Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Sam El Abbadi
- Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Kan Tsao
- Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| |
Collapse
|
2
|
Deganello A, Bosio P, Giannini L, Parolini F, Berretti G, Sordi A, Rampinelli V, Gualtieri T. Matrix for Mucosal Regeneration in Transoral Glossectomy for Squamous Cell Carcinoma: Objective and Subjective Functional Evaluation. Curr Oncol 2023; 30:1354-1362. [PMID: 36826065 PMCID: PMC9954828 DOI: 10.3390/curroncol30020104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Numerous options to manage local reconstruction following transoral partial glossectomy are possible. In this work, we present our experience using a matrix for mucosal regeneration, Integra®, after transoral resections of squamous cell carcinoma of the oral tongue. METHODS A retrospective analysis of patients treated for tongue carcinoma and reconstruction with Integra®, from September 2017 to September 2022. Functional outcomes were evaluated by measuring swallowing and speech abilities, tongue motility, and subjective quality of life. RESULTS The series accounts for 13 consecutive patients, staged from Tis to T3, no positive resection margins were found, average defect size was 17.8 cm2. The average histologically measured depth of invasion was 4.1 mm (range 2-12 mm), and no recurrences were observed during follow-up. All patients maintained excellent swallowing function, the average number of recognized words by an external listener during a phone call was 70.5 out of 75, the lingual motility test was good (a mean score of 4.5 out of 6 movements correctly executed) and subjective questionnaires results were optimal. Less satisfying functional results were recorded in elderly patients receiving a wider surgical resection. CONCLUSIONS This reconstructive technique for allows obtaining optimal healing and functional outcomes in patients with tumors suitable for transoral glossectomy.
Collapse
Affiliation(s)
- Alberto Deganello
- Otolaryngology Head and Neck Surgery Department of IRCCS, National Cancer Institute (INT), 20133 Milan, Italy
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
- Correspondence: ; Tel.: +39-0223902793
| | - Paolo Bosio
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Lorenzo Giannini
- Otolaryngology Head and Neck Surgery Department of IRCCS, National Cancer Institute (INT), 20133 Milan, Italy
| | - Federico Parolini
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Giulia Berretti
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Alessandra Sordi
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Vittorio Rampinelli
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Tommaso Gualtieri
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| |
Collapse
|
3
|
Consorti G, Catarzi L, Messi M, Valassina D, Balercia P. New Tunneled Buccal Fat Pad Flap for Palatal Reconstruction. Craniomaxillofac Trauma Reconstr 2022; 15:90-94. [PMID: 35265283 PMCID: PMC8899347 DOI: 10.1177/1943387520988433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the palatal defects due to surgical resection, flap selection is very important for a correct reconstruction. Different methods have been suggested over the time, however the pedicled buccal fat pad is a simple, effective, reliable flap for reconstruction after palate tumor resection. The aim of the present study is to introduce a new surgical technique for palate reconstruction with pedicled buccal fat pad flap exposing the advantages. The Authors performed this procedure in 17 patients in order to treat medium-sized oncologic surgical defect of palate region in the period between 2016 and 2019. Complete wound healing after only 4 weeks without complication after 12 months follow-up was observed. This is the first cases series described with this new technique.
Collapse
Affiliation(s)
- Giuseppe Consorti
- Maxillo-Facial Surgery Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti di Ancona,” Umberto I, Ancona, Italy,Giuseppe Consorti, MD, Maxillo-Facial Surgery Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti di Ancona,” Umberto I, via Conca 71, Ancona 60126, Italy.
| | - Lisa Catarzi
- Maxillo-Facial Surgery, University of Siena, Siena, Italy
| | - Marco Messi
- Maxillo-Facial Surgery Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti di Ancona,” Umberto I, Ancona, Italy
| | - Davide Valassina
- Maxillo-Facial Surgery Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti di Ancona,” Umberto I, Ancona, Italy
| | - Paolo Balercia
- Maxillo-Facial Surgery Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti di Ancona,” Umberto I, Ancona, Italy
| |
Collapse
|
4
|
Matsumoto H, Kimata Y, Ota T, Sugiyama N, Onoda S, Makino T, Takeda S, Mizukawa N. Morphological Changes and Durability of Skin and Mucosal Flaps in Intraoral and Pharyngeal Reconstructions: Long-term Follow-up and Literature Review for Potential Second Carcinomas. Acta Med Okayama 2021; 75:725-734. [PMID: 34955541 DOI: 10.18926/amo/62813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The long-term changes in tissues implanted in the oral cavity and pharynx after head and neck reconstruction have not been fully evaluated. This study aimed to clarify the morphological changes, long-term durability, and potential for secondary carcinogenesis in such tissues. In our single-center study, the rough morphological changes in 54 cases of intraoral and pharyngeal skin and mucosal flaps were evaluated more than 10 years after flap transfer. In addition, the literature on the development of second carcinomas from skin flaps was reviewed. The mean follow-up period for transferred flaps was 148 months. The reconstruction areas and the probability of morphological changes were significantly correlated (p=0.006), especially in cases with tongue, lower gingiva, and buccal mucosal reconstruction. Free jejunal flap surfaces were well maintained, whereas tubed skin flaps showed severe morphological changes in cases with pharyngeal reconstruction. None of the flaps in our series developed second primary carcinomas. Skin flaps generally had good durability for > 10 years in intraoral environments, while mucosal flaps had better durability for pharyngeal reconstruction. Second squamous carcinomas arising from skin flaps are extremely rare; however, surgeons should take this possibility into consideration and conduct meticulous and long-term follow-up.
Collapse
Affiliation(s)
- Hiroshi Matsumoto
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Yoshihiro Kimata
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Tomoyuki Ota
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Narushi Sugiyama
- Department of Plastic and Reconstructive Surgery, Japanese Red Cross Okayama Hospital
| | - Satoshi Onoda
- Department of Plastic and Reconstructive Surgery, Kagawa Rosai Hospital
| | - Takuma Makino
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Seiko Takeda
- Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Hospital
| | - Nobuyoshi Mizukawa
- Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| |
Collapse
|
5
|
Tousidonis M, Escobar JIS, Caicoya SO, Vila CN, Cuéllar IN, Montiel AD, López AML, Cuéllar CN. Preoperative Doppler Ultrasonography Allen Test for Radial Forearm Free Flap in Oral Cancer Reconstruction: Implications in Clinical Practice. J Clin Med 2021; 10:jcm10153328. [PMID: 34362111 PMCID: PMC8347905 DOI: 10.3390/jcm10153328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022] Open
Abstract
The Radial Forearm Free Flap (RFFF) is one of the most widely used microsurgical flaps for intraoral reconstruction. Although the Clinical Allen Test (CAT) is the most widely used preoperative diagnostic method with which to study the distal patency of the hand prior to the use of RFFF, several authors have reported potentially preventable serious vascular complications. This study included 87 consecutive patients with cancer of the oral cavity and RFFF as the flap of choice who were treated between 2010 and 2020, and compares the results of the Clinical Allen Test (CAT), the Doppler Allen Test (DAT) and the Surgical Allen Test (SAT). The preoperative vascular study found vascular abnormalities severe enough for the surgical team to change the preoperative flap of choice in 39% of patients. The Kappa index showed a weak concordance between the CAT and DAT. The study reflected a total concordance in the preoperative results of the Doppler study and the intraoperative results of the SAT. Due to its excellent agreement with SAT, the DAT would be the preoperative test of choice in patients who are candidates for RFFF. This study of vascular mapping tests with Doppler is intended to inform therapeutic decisions and present methods to gain information that cannot be obtained by physical examination alone.
Collapse
|
6
|
Srivastava A, Maniakas A, Myers J, Chambers MS, Cardoso R. Reconstruction of intraoral oncologic surgical defects with Integra ® bilayer wound matrix. Clin Case Rep 2021; 9:213-219. [PMID: 33489162 PMCID: PMC7813028 DOI: 10.1002/ccr3.3501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 12/01/2022] Open
Abstract
Utilization of biologic skin substitutes for the management of soft tissue defects as an alternative to autologous skin grafts has expanded over the past 2 decades. The purpose of this case series study was to report our experience with Integra® bilayer wound matrix for reconstruction of intraoral oncologic defects. Case records of 6 patients with intraoral oncologic defects reconstructed with Integra® bilayer wound matrix were retrospectively reviewed. The surgical defect location, size, and time to removal of surgical splint varied. Clinically, normal oral epithelialization was noted for all patients. One patient demonstrated a small area of dehiscence and bone exposure after adjuvant radiation therapy which resolved with minimal intervention. Integra bilayer wound matrix is a viable and versatile option for reconstruction of intraoral oncologic surgical defects. Further exploration of wound healing with Integra® matrix, surgical techniques, and cost-effectiveness is advocated.
Collapse
Affiliation(s)
- Akanksha Srivastava
- Department of Restorative Dentistry and ProsthodonticsThe University of Texas School of DentistryHoustonTXUSA
| | - Anastasios Maniakas
- Department of Head and Neck SurgeryDivision of SurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Jeffrey Myers
- Department of Head and Neck SurgeryDivision of SurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Mark S. Chambers
- Section of Oral Oncology and Maxillofacial ProsthodonticsDepartment of Head and Neck SurgeryDivision of SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Richard Cardoso
- Section of Oral Oncology and Maxillofacial ProsthodonticsDepartment of Head and Neck SurgeryDivision of SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| |
Collapse
|
7
|
Patel H, Saadat N, Ho AS, Mallen-St Clair J. Virtual Surgical Planning for Bisphosphonate-Related Osteonecrosis of the Jaw: A Valuable Application in Advanced Cases. Cureus 2020; 12:e9696. [PMID: 32923286 PMCID: PMC7486086 DOI: 10.7759/cureus.9696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare but potentially devastating complication of extended use of bisphosphonates. fibula free flaps (FFFs) are the gold standard of mandibular reconstruction. Virtual surgical planning (VSP) is a technique that utilizes high-definition three-dimensional reconstructions that enable the production of highly accurate intra-operative surgical guides and templates that help guide osteotomies and fibula contouring. The aim of this report is to highlight the value of VSP in the surgical management of advanced BRONJ. We report a case study of a woman with advanced BRONJ that required an angle-to-angle mandibular resection with subsequent reconstruction with an FFF. VSP was used to improve the accuracy of the reconstruction and minimize ischemia time. We present the first reported case of the successful implementation of VSP for the planning of FFF reconstruction for a woman with advanced symptomatic BRONJ that had failed conservative measures.
Collapse
Affiliation(s)
- Harsh Patel
- Plastic and Reconstructive Surgery, University of California, Los Angeles School of Medicine, Los Angeles, USA
| | - Nariman Saadat
- Oral and Maxillofacial Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Allen S Ho
- Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Jon Mallen-St Clair
- Otolaryngology - Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| |
Collapse
|
8
|
Scarano A, Lorusso F, Di Cerbo A, Lucchina AG, Carinci F. Eradication of hairy mouth after oncological resection of the tongue and floor mouth using a diode laser 808 nm. Postoperative pain assessment using thermal infrared imaging. Lasers Surg Med 2019; 51:516-521. [PMID: 30614012 DOI: 10.1002/lsm.23054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Vascularized soft tissue flaps are often harvested from hair-bearing areas, such as the radial forearm or anterolateral thigh, making their use in oral reconstruction problematic due to postoperative hair growth. The presence of intact hair follicles in free tissue transfer and continued hair growth at the recipient site can result in difficulties with oral hygiene, intraoral irritation, food trapping, and patient distress. This study was to evaluate the intraoral efficacy and safety of a diode laser 808 nm when used for hair removal. MATERIALS AND METHODS Sixteen male patients, between 2010 and 2017, were referred for intraoral hair eradication with a history of squamous cell carcinoma of the tongue or floor mouth resection. An 808 nm diode laser (Stark 808, Plume s.r.l., Rome, Italy) was used to remove the intraoral hair. Each patient received a total of six treatments at 4-week intervals. Perifollicular pain was quantified by the physician using visual analog scales. Follow-up visits were scheduled at 1, 4, and 6 days to check the state of the tissues. The recall program included assessments of VAS, erythema, and perifollicular temperature. Patients were followed up for long-term assessments at 6 and 12 months after the final treatment session. RESULTS All patients presented well with no occurrence of symptoms, indicating possible perifollicular inflammation. Based on the VAS scores, very mild discomfort during laser irradiation was recorded in all patients, with average pain score of 10.98 ± 1.42. No pain or discomfort was recorded 1, 4, and 6 days after the procedure. After the third pulse of light was applied, the average temperature with standard deviation of the hair tip with both the dark and light skin was 74.4 ± 11.7°C. The difference in temperature before the procedure (basal measurement 37.5 ± 2.8°C) and immediately after laser irradiation was 36.9 ± 3.7°C. The difference in temperature disappeared after 0.29 seconds, and no temperature increase was recorded on days 1, 4, or 6. In all the patients, the hair clearance between baseline and the 6th treatment, the 6-month follow-up, and the 12-month follow-up rated as significant P < 0.05. The mean percentage of hair reduction was 97.3% at 12 months. CONCLUSION In conclusion, the clinical findings demonstrate the safety and efficacy of the 808 nm diode laser system for intraoral hair removal Lasers Surg. Med. 51:516-521, 2019. © 2019 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Antonio Scarano
- Department of Medical, Oral and Biotechnological Sciences and CeSi Met, University of Chieti-Pescara, Chieti, Italy
| | - Felice Lorusso
- Department of Medical, Oral and Biotechnological Sciences and CeSi Met, University of Chieti-Pescara, Chieti, Italy
| | - Alessandro Di Cerbo
- Department of Medical, Oral and Biotechnological Sciences and CeSi Met, University of Chieti-Pescara, Chieti, Italy.,Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberta Greco Lucchina
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy.,University of Eastern Piedmont, Novara, and Oral Surgery Unit, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Francesco Carinci
- Department of Morphology, Experimental Medicine and Surgery, University of Ferrara, Ferrara, Italy
| |
Collapse
|
9
|
Abstract
Objectives The submental flap provides an alternative technique in orofacial reconstruction, especially in situations where free flap services are not available. The objective of this study is to demonstrate the oncological safety and benefits of this flap in oral cavity reconstruction in a tertiary care cancer hospital. Materials and Methods A total of 27 patients with oral cavity cancers, which underwent submental flap reconstruction from 2015 to 2017 at Shaukat Khanum Cancer Memorial Hospital, were included in the study. We have retrospectively reviewed records of these patients. Results There were 25 male and 2 female patients with age ranging from 21 to 73 years. Most common primary tumor sites were buccal mucosa (13), tongue (7), and lower alveolus (7). All patients underwent ipsilateral selective neck dissection after flap was harvested. Complete flap loss was observed in three, whereas one patient had flap dehiscence that subsequently healed. Mean follow-up was 11 months. There were four regional recurrences but no local recurrence. On the last follow-up (minimum 6 months), 15 patients were alive without any disease, 4 were alive with disease, and 3 had died. Conclusion Submental flap is a satisfactory option for oral cavity reconstruction. However, preoperative selection of clinically neck node-negative patient is extremely important as it has potential risk of occult metastasis.
Collapse
Affiliation(s)
- Muhammad Faisal
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Mohammad Adeel
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Sheryar Riaz
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Abdullah Anwar
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Asma Rashid
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Sadaf Usman
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Arif Jamshed
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Raza Hussain
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| |
Collapse
|
10
|
Habib AMA, Medra A. The Feasibility of Buccal Fat Pad Flap in Oral Reconstruction Based on Clinical Experience in a Governmental Hospital, Alexandria, Egypt. Cleft Palate Craniofac J 2015; 53:657-663. [PMID: 26606163 DOI: 10.1597/15-106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the pedicled buccal fat pad flap for its applicability in the reconstruction of surgically created oral defects. We highlighted the technique of flap harvesting, its different applications, and limitations. DESIGN Prospective analysis of patients with intraoral defects repaired by the buccal fat pad flap. SETTING Institutional center. PATIENTS/PARTICIPANTS Twenty-nine patients with surgical defects of the palate, maxilla, upper gingiva, buccal mucosa, lower gingiva, retromolar region, oral floor, and temporomandibular joint. INTERVENTIONS Pedicled buccal fat pad flap for treatment of small to medium-sized intraoral defects. OUTCOME MEASURES Patients had repair using a pedicled buccal fat pad flap between 2012 and 2014. Patients' photographs and clinical records were collected. The technique of flap harvesting, its advantages, and its drawbacks are described in this study. RESULTS Patients were followed up over a mean period of 13.7 months to check flap viability, competent repair, and donor site function and aesthetics. Complete epithelialization was observed within 4 to 6 weeks postoperatively according to the extent of the defect. All patients showed uneventful healing without complications. CONCLUSIONS Buccal fat pad flap proved to be feasible for the reconstruction of surgically induced proximal small to medium-sized defects and can be extended to the palate, mandible, mouth angle, and temporomandibular joint region. Further research using preoperative computed tomography or magnetic resonance imaging for evaluation of the size of the buccal fat pad is needed when reconstructing large distal defects.
Collapse
|
11
|
Abstract
The buccinator-based myomucosal flaps are axial pattern flaps that are suitable in reconstruction of medium sized oral soft tissue defects; they are rich in blood supply, have appropriate thickness and considerable mucosal paddle, and they can secrete saliva. The present study describes surgical anatomy and blood supply of these flaps and demonstrates all possible modifications of these flaps (9 modifications). Many terms (> 10) have been used to refer to buccinator-based myomucosal flaps in the literatures. This report introduces a new classification system mainly based on the remaining attachments of buccinator muscle after flap elevation in pedicle variants and axial blood supply orientation in island variants.
Collapse
Affiliation(s)
- Amin Rahpeyma
- Oral and Maxillofacial Diseases Research Center, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | | |
Collapse
|