ABSTRACT
OBJECTIVE: To evaluate the usefulness of supraclavicular artery flap in reconstruction of defects following resection of buccal mucosa cancer. METHODS: Twenty-five patients who presented to R.L Jalappa Hospital and Research centre and diagnosed as squamous cell carcinoma of buccal mucosa staged T2 and above were included in our study. All patients underwent wide excision of tumour and neck dissection. Six patients underwent hemi-mandibulectomy while 4 patients underwent marginal mandibulectomy depending on extent of the tumour along with neck dissection. The defect following surgery was reconstructed using the supraclavicular artery flap and were followed up for minimum 6 months during which they were assessed for the functional and aesthetic outcome using a scoring system. The details of the scoring system comprised of 7 attributes. Each attribute was given a score of 10 if the patients experienced that attribute, while a score of 0 was given if the patient did not experience that particular attribute. RESULTS: Seven (28%) patients had complete necrosis of the flap. One patient had a local recurrence 2 months following surgery and was lost to follow up. The remaining 17 patients were followed up for a minimum of 6 months and a scoring system was adopted to evaluate the functional and aesthetic outcome of the supraclavicular flap. We observed that 14 patients had an excellent outcome score (58%), 3 patients had a good outcome score (13%), while 7 patients (28%) had flap necrosis. CONCLUSIONS: We find the supraclavicular flap to be safe, technically simple, sensate, thin, pliable and reliable regional fasciocutaneous flap in reconstructing intra oral defects. Preserving the external jugular vein and sacrificing supraclavicular nerves give good outcome.
ABSTRACT
Carcinoma buccal mucosa is the most common oral cavity cancer in India. Following excision of these lesions the defects can be reconstructed using various reconstructive techniques. Buccal pad of fat has been successfully used in the reconstruction of small palatal defects and in the closure of the oro antral fistula. This study aims at evaluating the role of buccal pad of fat in reconstruction of defects following excision of the small to medium premalignant lesions and T1-T2 malignant lesions of buccal mucosa. This study has 20 patients who presented between January 2013 and January 2015, with biopsy proven premalignant lesions and early malignant lesions in the buccal mucosa. The lesions were excised and reconstructed with buccal pad of fat. Patients were followed up for a period of 3 months, in this period were evaluated for flap epithelisation, postoperative complications like flap necrosis and infection and also the functional outcomes of the flap. In our study complete epithelisation of the flap was seen in all patients. Wound dehiscence was seen in three patients with larger defetcs(>5 cm). None of our patients had any post operative morbidity. This flap is therefore an excellent reconstruction technique for small to medium buccal mucosa defects as it is convenient, reliable, fast, has rich vascularity, easy accessibility, fewer complications and minimal or no donor site morbidity.
ABSTRACT
OBJECTIVE: To evaluate the margins of resected specimen of oral squamous cell carcinoma (SCC) and to document the surgical margin (measured at the time of resection) and margins at the time of pathological examination (after immersion of the specimen in formalin). METHODS: Patients who were diagnosed and confirmed with squamous carcinoma of buccal mucosa were included in the study. Patients underwent resection of the tumor with a margin of 1 cm. Soon after resection, the distance between outermost visible margin of the tumor and the margin of the specimen was measured and documented. Specimens were fixed in 10% formalin and submitted for gross and histopathological examination. The closest histopathologic margin was compared with the in situ margin (10 mm) to determine and document any shrinkage of the margin and the percentage of discrepancy if any. RESULTS: A total of 52 specimens were collected from patients between January 2014 and December 2014. All specimens were obtained from the oral cavity (n = 52) of which 43 (82.7%) were squamous cell carcinoma and 9 (17.3%) were verrucous variant of squamous cell carcinoma. The average decrease in tumor margins measured after fixation in formalin was found to be statistically significant (P < 0.05) in 65% of cases. CONCLUSION: Tumor margin shrinks significantly after formalin fixation by about 25%. The operating surgeon and pathologist should be well aware of such changes while planning for further management thereby ensuring adequate margin of resection and adjuvant treatment wherever required to prevent possible local recurrence of the disease.
