Full cheek defect reconstruction using ALTF versus RFF: Comparison of quality of life, clinical results, and donor site morbidity

Comparison of Flaps From Different Sites for Repairing Postoperative Soft Tissue Defects Regarding the Quality of Life in Patients With Oral Cancer: A Systematic Review

This study aims to compare flaps at different sites in treating soft tissue defects after oral cancer surgery and improving patients' quality of life (QoL). Databases were searched until September 2023. The extracted data included the scores of chewing, swallowing, speech, mood, and appearance based on the University of Washington QoL questionnaire, version 4. Two types of free flaps and 2 types of pedicled tissue flaps were included. The free flaps were the forearm free flap (FFF) and anterolateral thigh flap, and the pedicled tissue flaps were the submental artery island flap and pectoralis major myocutaneous flap (PMMF). Compared with FFF, there was no significant difference in the scores of chewing, swallowing, speech, and mood among anterolateral thigh, submental artery island flap, and PMMF, and PMMF generally had a higher score than FFF only in terms of appearance, with statistical significance. There is no significant difference in chewing, swallowing, speech, and mood between flaps from different sites in repairing postoperative soft tissue defects of oral cancer. Therefore, the widely used FFF may be the preferred choice considering the QoL of patients after oral cancer surgery.

Modified submandibular mandibulotomy approach versus lip-splitting approach in tongue cancer surgery: a retrospective paired-cohort study

OBJECTIVES

The surgical approach for resection and reconstruction of tongue cancer (TSCC) with or without the lip-splitting incision is controversial. This study introduced a modified approach without lip-splitting and the clinical results were assessed.

METHODS

Sixty-eight TSCC patients underwent surgery using the modified submandibular mandibulotomy (MSMM) approach without lip-splitting, and another matched 68 patients using lip-splitting mandibulotomy (LSM) approach were enrolled in this study. The clinical results including intraoperative relevance and surgical morbidities, survival status, facial appearance and scar scores, function of lower lip, and quality of life (QOL) were evaluated.

RESULTS

The primary tumors were en bloc resected through the MSMM approach with excellent tumor exposure and R0 resection margins as LSM approach. The survival status and complications were similar in both groups. The function of lower lip was better in patients of MSMM group at 1 month after surgery. The MSMM approach was associated with significantly better facial appearance and recreation compared to LSM approach by scar scores and QOL assessment.

CONCLUSION

The MSMM approach without lip-splitting achieves similar tumor control, better aesthetic results, and QOL compared to LSM approach. It is a safe and effective surgical approach for patients with TSCC.

CLINICAL RELEVANCE

The MSMM approach without lip-splitting is oncological safety in tongue cancer surgery and is scrutinized as one part of the treatment concept for better aesthetic results.

Functional Reconstruction of Through and Through Cheek Defect with Free Composite Bi-pedalled Anterolateral Thigh Flap

Extensive composite defects involving the lip and cheek present difficult reconstructive challenges in view of functional recovery like oral competence, articulation, speech and mastication. This study presents our results of reconstructing through and through cheek defect with the use of free anterolateral thigh (ALT) flaps. All the patients with carcinoma of buccal mucosa and cheek who underwent through and through cheek resection and reconstructed with free composite pedalled anterolateral thigh flap between March 2019 to March 2020 were included in the study. We have assessed the post-operative functional outcome using University of Washington Quality of Life Questionnaire at the end of 12 months duration. We have excluded lost to follow-up and flap failure patients. Fifty patients were matched our inclusion criteria. Mean age was 43 years. Male to female ratio was 4.6:1. Stage 3 disease was in 8 patients and stage 4 disease was in 42 patients. Average size of the flap required was 15 × 7.5 cm, maximum was 24 × 11 cm. Oral competence was good in 74% patients. 80% patients were able to take semisolid diet, 8% were on liquid diet and 12% were dependent on RT feed. Average physical function (70.47 ± 19.09), social-emotional sub-score (81.72 ± 16.63) and composite scores (76.09 ± 17.86) were good and within acceptable range. Chewing (53 ± 29.29) and swallowing (64 ± 21.57) scored poorly among 12 domains. For extensive through and through cheek defects bipedelled ALT provides good functional outcome. In view of advance disease status extensive resection would be responsible for bone and mucosal loss affecting chewing and swallowing.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03416-3.