Is there still a role for bilobed/bipaddled pectoralis major myocutaneous flap for single-stage immediate reconstruction of post ablative oncologic full-thickness defects of the cheek?

INTRODUCTION: Reconstruction of full-thickness defects of the head and neck is a challenge. In this clinical study, we assessed the role of the bilobed/bipaddled pectoralis major myocutaneous flap (PMMF) for the reconstruction of large full-thickness defects of the cheek, after resection of oral cancer. MATERIALS AND METHOD: After resection of oral cancer, 62 cases of through-and-through defects of the oral cavity were reconstructed using folded/bipaddled/bilobed PMMF flap. All were males and presented with locally advanced oral squamous cell carcinoma (SCC), which involved the buccal mucosa and gingivo buccal sulcus (n = 53) and gingivo buccal sulcus + lip (n = 9). RESULTS: All the flaps survived, and no patient developed a major complication. The most common complication in the current series was wound dehiscence. In 8% of cases, wound dehiscence was found at the donor site; in 6.45% of cases, dehiscence was present at the recipient site; and in 4.83% of cases, dehiscence was present at the neck. All the wounds healed secondarily with regular dressings. CONCLUSION: The bilobed/bipaddled PMMF is a straightforward and reliable flap that provides an effective mechanism to reconstruct full-thickness cheek defects while avoiding the complexity of microvascular free flaps. The bilobed/bipaddled PMMF has become our preferred reconstruction option for large full-thickness defects after resection of oral carcinoma.

Schwannoma of the tongue in a paediatric patient: a case report and 20-year review.

Schwannomas (Neurilemmomas) are benign, encapsulated, slow-growing, and usually solitary tumours originating from Schwann cells of the peripheral nerve sheath with uncertain etiology. Approximately 25-48% of cases are seen in the head and neck region, of which 1% appears in the oral cavity. Lingual schwannoma can affect all age groups with peak incidence between the third and sixth decade. We report a rare case of lingual schwannoma in a 14-year-old girl complaining of asymptomatic swelling over lateral border of tongue since two years. Clinical examination revealed a nodule 1.5 × 1 cm in size, rubbery, nontender, smooth at right lateral border of tongue covered by normal mucosa, with no cervical lymphadenopathy. Excisional biopsy of the lesion was done under local anaesthesia. The histological sections spindle cells with thin wavy nuclei arranged as typical Antoni A (with Verocay bodies) and Antoni B areas. Nuclear palisading distribution (typical of a schwannoma) was readily identifiable. The patient was recurrence-free after one year.