Selective variants for postoncological oro-mandibular reconstruction

ABSTRACT

Squamous cell carcinoma of the head and neck is a challenging disease to both surgeons and radiation oncologists due to proximity of many important anatomical structures. Reconstructive methods follow the principle of what is removed should be either repaired or replaced. Thus reconstruction of oromandibular defects after resection of tumors allows surgeons to resects tumors without fear of reconstruction of large defects. The aim of this study is to evaluate the aesthetic and functional outcome after reconstruction of oromandibular defects by selective variants of flap and to evaluate different techniques of these flaps in reconstruction of oro-mandibular defects after tumors resection by either free microvascular flaps or local and regional flaps as regard indication, reliability, donor sites morbidity, complications. The study involves a total of 41 patients with oro-mandibular tumors whose need reconstructions flaps after tumor resection and they admitted to National Cancer Institute [NCI] and South Egypt Cancer Institute [SECI], Egypt, during the period from January 2009 till January 2011.The reconstruction either immediate in 38 patients [92.7%] or delayed reconstruction after tumor resection within 1-3 years by free flaps after previous tumor resection in 3 patients [7.3%].The flaps used for reconstruction was grouped in two groups, group I include 21 patients who reconstructed by local and regional flap and group II include 20 patients who reconstructed by free flaps. The 41 patients enrolled in this study were 23 males [56%] and 18 females [44%]. The male female ratio was 13. The age range of the enrolled patients was 13-80 years with average age of [53.4 +/- 12.9 years] in group I and [32.9+ 14 years] in group lithe mean age 53.4 years in group I and 32.9 years in group II. In group I most common presentation is lower alveolar margin ulcerative lesion [28.6%] then malignant tongue ulcer but in group II most patients [10 patients] presented with jaw swelling that represent 50% of cases of that group. The commonest histopathology of the operated patients was squamous cell carcinoma which presented in 24 patients [58.5%], 16 in group I and 8 in group II. Local complications were recorded in 16 patients [39%] [12 in group I and 4 in group II], of them 2 patients [4.9%] with total flap loss and one patient died from cardiopulmonary arrest. The overall success rate was 95% in both groups. postoperative functional and cosmetic assessment for 38 patients in both groups [both groups regarding pain 57.9% of patients had no pain with p value = 1.000 [>0.05], as regard to speech 47.3% in group I and 57.9% in group II have normal speech with p value 0.648 [>0.05], as regard to swallowing was 63.1% in group I and 84.2% in group II of patients can swallow normally with p value = 0.141 [>0.05], As regard cosmetic appearance 47.4% in group land 26.3% in group II of patients have no change in the appearance with p value = 0.379 [>0.05]. Regional flap as PMMF that cover a bridging titanium plate and other flap as submental, deltopectoral and nasolabial flaps are a reliable and effective method for reconstruction of oro-mandibular defect and allow improvement of pain and restoration of speech, chewing, swallowing, and aesthetic contour of face but Free tissue transfer is the preferred method of reconstructing large oromandibular defects and central defects