Buccal mucosal transposition flap for reconstruction of oropharyngeal-oral cavity defects: an analysis of six cases

Orocutaneous Fistula After Oral Cavity Resection and Reconstruction: Systematic Review and Meta-Analysis

OBJECTIVE

Orocutaneous fistula (OCF) after reconstruction for oral cavity resection can lead to prolonged hospitalization and adjuvant treatment delay. Few studies have examined factors leading to OCF after oral cavity resection. Primary objective: evaluate overall incidence and factors associated with OCF after oral cavity reconstruction.

DATA SOURCES

Scopus 1960-database was searched for terms: "orocutaneous fistula," "oro cutaneous fistula," "oral cutaneous fistula," "orocervical fistula," "oral cavity salivary fistula."

REVIEW METHODS

English language studies with >5 patients undergoing reconstruction after oral cavity cancer resection were included. About 1057 records initially screened; 214 full texts assessed; 78 full-texts included. PRISMA guidelines were followed, and MINORS criteria used to assess risk of bias. Data were pooled using random-effects model. Primary outcome was OCF incidence. Meta-analysis to determine the effect of preoperative radiation on OCF conducted on 12 eligible studies. Pre-collection hypothesis was that prior radiation therapy is associated with increased OCF incidence. Post-collection analyses: free versus pedicled flaps; mandible-sparing versus segmental mandibulectomy.

RESULTS

Seventy-eight studies were included in meta-analysis of overall OCF incidence. Pooled effect size showed overall incidence of OCF to be 7.71% (95% CI, 6.28%-9.13%) among 5400 patients. Meta-analysis of preoperative radiation therapy on OCF showed a pooled odds ratio of 1.68 (95% CI, 0.93-3.06). OCF incidence was similar between patients undergoing free versus pedicled reconstruction, or segmental mandibulectomy versus mandible-sparing resection.

CONCLUSION

Orocutaneous fistula after oral cavity resection has significant incidence and clinical impact. Risk of OCF persists despite advances in reconstructive options; there is a trend toward higher risk after prior radiation.

Versatility of Tongue Flaps for Closure of Palatal Defects- Case Report

Palatal defects following congenital anomalies, traumatic injuries, benign and malignant pathologies frequently require resection and reconstruction. Reconstruction of these defects is challenging and complex due to the amount of tissue left for primary closure after excision, compromised vasculature as on repaired cleft palate and limited pedicled flaps around the lesion. Tongue flap though doesn't fulfil all the ideal requirements of a flap, however because of its flexibility, good blood supply and position it can be considered as the best among other flaps for reconstruction of oral and palatal defects. In this article we describe two different cases in which tongue flap was used to reconstruct palatal defects, one an oroantral communication secondary to a tumour excision and the other an oro-nasal fistula secondary to cleft palate repair.

Buccinator-based myomucosal flaps in intraoral reconstruction: A review and new classification

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.

[Soft palate reconstruction]

Soft palate reconstruction is complex. It has to restore swallowing and speech replacing the defect by dynamic and sensitive tissues. The means are multiple from direct suture to free flaps. Local flaps have the advantage to bring a mucosa animated by thin muscles, like in sphincteroplasty. Free flaps allow reconstruction of large defects, but they need some local adaptation (association with a local flap, adherence, suspension with tendon…) to improve the functional result. Indications depend on defect's size and local condition especially radiotherapy history.

[Buccal flap in reconstruction of mucosal defects in oral cavity]

INTRODUCTION

The buccal flaps are an effective alternative in treatment patients with small defects of the oral cavity due to: the small size of the flap, the lack of donor site, less risk of postoperative complications and short procedure time.

MATERIAL AND METHODS

In the Department of Otolaryngology and Laryngological Oncology in Poznan in the years 2005-2008 was performed 7 resections of oral cavity due to cancer in which the reconstructions were based on two types of flaps: from the buccal mucosa (3 patients), and muscular-buccal mucosal flap (4 cases). The paper presents aspects of the anatomical structure of the cheek and technique for flap dissection.

RESULTS AND CONCLUSIONS

In the majority group of patients the primary defect healing properly. The mucosal buccal flaps are a good alternative to free flaps, but their indications are limited to the primary defects of small extent.

Reconstruction of a defect on the buccal mucosa and prolabium

We describe the procedure for reconstruction of a defect on the buccal mucosa and the prolabium with a buccal mucosal transposition flap and an artificial dermis graft. The preparation of the flap started with an incision extending from the border of the defect to the corner of the mouth. The pivot point of the flap was near the stump of the excised prolabium. Only the buccal mucosa was elevated from the buccal surface. It was transposed onto the defect of the prolabium and sutured to the edges of the defect. After reconstruction of the prolabium, the artificial dermis was trimmed and sutured to the mucosal and skin edges of the surgical defect. This is an easy and minimally invasive procedure to cover a defect of the buccal mucosa and the prolabium. In our experience, the wound healed with good, functional, and cosmetic results.

Application of platysma-based transpositional flap for through-and-through facial defect when the facial artery circulation is blocked or compromised

PURPOSE

A novel use of site-limited platysma-based transpositional flap is demonstrated and discussed for the reconstruction of facial defects.

MATERIALS AND METHODS

Between January 1985 and January 2001, 342 patients were operated on for advanced oral-oropharyngeal and orofacial cancers. In 6 cases, a platysma-based transpositional flap was used for external closure of facial through-and-through defects. Internally, the saved oral mucosa was used in 4 patients and fasciocutaneous forearm free flaps in 2 patients. The facial artery was blocked in all cases.

RESULTS

The postoperative course was uneventful except in 1 case, when partial loss of the flap was observed intraorally. The externally used transpositional platysma-based flap showed cosmetic and functional advantages: its consistency, color, and texture were similar to those of the original facial tissues, the area of operation was the same, and the donor site was closed primarily.

CONCLUSION

The site-limited platysma-based myocutaneous transpositional flap is usable and safe even in those cases in which circulation of the facial artery is damaged or local vascular compromise has occurred and the facial through-and-through defect is extended. The facial reconstruction described is one of several applicable reconstructive methods that may be chosen for special facial defects. The method is not applicable when the neck is radically operated on (radical neck dissection) and/or irradiated. No similar use of platysma-based transpositional flaps has been reported thus far.