Lateral approach is a more aesthetical option for radical resection of BSCC: assessment of its surgical, oncological, functional, and aesthetic outcomes.

BACKGROUND: The purpose of this study was to introduce a modified lateral approach for combined radical resection of buccal squamous cell carcinoma (BSCC) and evaluate its surgical, oncological, functional, and aesthetic outcomes in comparison with the conventional lower-lip splitting approach. METHODS: This single-center study retrospectively reviewed 80 patients with BSCC, of which 37 underwent the lateral approach and 43 underwent the conventional approach. Surgical, functional, oncological, and aesthetic evaluations, as well as follow-ups, were recorded and compared. RESULTS: Compared to the conventional approach group, the lateral approach group had a longer surgical time (P = 0.000), but there was no significant difference in other surgical and oncological parameters. Moreover, the scar in the head and neck had a significantly discreet appearance in the lateral approach group, whose satisfaction was better than those in the conventional approach group (P = 0.000). Other oral function parameters, postoperative mouth-opening, and 3-year survival rate were not significantly different between the two groups. CONCLUSION: The lateral approach could provide superior aesthetic results while maintaining equal surgical, functional, and oncological outcomes compared to the conventional approach for radical resection of BSCC.

[Influence of mandibulotomy approaches on oral function following radical resection of tongue carcinoma].

OBJECTIVE: This study aimed to compare the influences of postoperative oral function in patients with median or paramedian mandibulotomy during the radical resection of tongue carcinoma and to provide evidence for the choice of osteotomy location for mandibulotomy. METHODS: The clinical data of 126 patients who underwent combined radical neck dissection with mandibulectomy and glossectomy followed by simultaneous reconstruction were analyzed retrospectively. The patients were divided into two groups according to the position of mandibulotomy: median mandibulotomy group (median group, n=60) and paramedian mandibulotomy group (paramedian group, n=66). The fourth edition of the University of Washington Quality of Life Questionnaire (UW-QOL) was used to compare the differences in oral functions, such as swallowing, mastication, and speech, between the two groups during regular follow-up. SPSS 24.0 software package was used for statistical analysis, and P<0.05 was considered statistically significant. RESULTS: Six months after the operation, no significant differences in swallowing, mastication, and speech functions were found between the median and paramedian groups. However, the swallowing and speech functions in the paramedian group were better than those in the median group 1 year after the operation (P<0.05), whereas no statistical difference in mastication function was observed between the two groups. CONCLUSIONS: Evaluation of the postoperative oral function results showed that paramedian mandibulotomy was a better surgical approach than median mandibulotomy. Paramedian mandibulotomy is worth prioritizing in the radical resection of tongue carcinoma.

[Application of the nasolabial fold "smile" incision approach in posterior buccal cancer ablation].

OBJECTIVE: This study investigated the feasibility and clinical result of radical resection of posterior buccal carcinoma by using the facial nasolabial fold "smile" incision approach. METHODS: From August 2016 to March 2017, 23 patients with posterior buccal carcinoma were included in this study and underwent radical surgery. Upon finishing the cervical lymph node dissection, an arc-shaped incision was made at 1 cm lateral to the ipsilateral angulus oris, extending along the nasolabial fold upward to the inferolateral margin of the nasal alar while downward in direct continuity with the neck dissection incision. RESULTS: Satisfactory exposure and easy resection of the primary tumor with negative surgical margin were achieved in all 23 patients. After 12-22 months of follow-up (16.5 months on average), all patients recovered favorably, and no local recurrence or distant metastasis was observed. Mouth opening was restored to normal in all cases. The scars were hidden in the nasolabial fold, thus named "smile" incision. CONCLUSIONS: For posterior buccal cancer patients, the facial "smile" incision approach can satisfy the need of surgical exposure, facilitate operative performance, and preserve the annular integrity of the lips without affecting the radical tumor ablation, thereby maintaining a favorable mouth opening. With these advantages, the "smile" incision approach is considered worthy of being popularized in clinical application.

Surgical management of primary and secondary tumors in the pterygopalatine fossa.

OBJECTIVE: This article describes a surgical approach that has been applied to managing primary tumors in the pterygopalatine fossa and secondary tumors involving the pterygopalatine fossa. PATIENTS AND METHODS: The Barbosa approach was modified by adding a lateral incision in the mandibular gingivobuccal fold from the canine tooth to the retromolar area. This technique was applied to nine patients with primary and secondary tumors in the pterygopalatine fossa. All patients had been observed by clinical examinations, MRI, and CT examinations. RESULTS: This technique allowed a large, inferiorly based flap to be raised, which includes the parotid gland. The masseter and temporalis muscles were divided horizontally, and the ascending ramus of the mandible was osteotomied between the mandibular angle and the sigmoid notch and reflected to expose the tumor in the pterygopalatine fossa and maxillary sinus. We have applied this technique in 9 patients. Of the 9 patients in our study, 5 (55%) were male and 4 (45%) were female. The median age of the patients at the time of operation for primary and secondary tumors in the pterygopalatine fossa was 49.5 years (range, 19-66 years). Four of the 9 patients had primary tumors in the pterygopalatine fossa. One patient had a tumor in the pterygoaplatine fossa extending into the maxillary sinus, 2 patients had tumors occurring in the maxilla involving the pterygopalatine fossa, 2 patients had tumors from the deep lobe of the parotid gland to the pterygopalatine fossa, and 1 patient had extracranial meningioma. Nine patients have been followed up from 3 months to 9 years and 6 months, and 1 patient had recurrence 2 years and 2 months postoperatively. CONCLUSION: This technique is especially useful to tumors in the pterygopalatine fossa and tumors in the pterygopalatine fossa extending into the maxillary sinus.

[Dumbbell-shaped cervical spinal neurilemmoma presenting as neck mass: diagnosis and treatment].

PURPOSE: Cervical neurilemmoma originating from cervical spine could extend through foramen intervertebrale and displayed a radiographic features as a cervical intra- and extra-spinal dumbbell-shaped mass.Because of its early compressive spine cord, patients usually visited neurosurgery at first. In this paper, two patients of cervical intra- and extra-spinal dumbbell-shaped neurilemmoma visiting oral and maxillofacial surgery complained of upper cervical mass were reported, aiming to improve the diagnostic and therapeutic skill for oral and maxillofacial surgeons. METHODS: Two case of cervical dumbbell tumors who complained of a neck mass underwent surgery and were followed up by oral and maxillofacial surgeons .The pathogenesis,operative approach and prognosis were discussed by reviewing relevant literatures retrospectively. RESULTS: Both of the two patients' presenting symptoms were upper-cervical masses. Preoperative imaging suggested trans-cervical vertebra dumbbell masses.The tumors were removed through combining the posterior midline and lateral cervical approach, and a gross total resection was achieved.No evidence of recurrence was noted after one-year of follow-up. CONCLUSIONS: The initial symptom of cervical intra- and extra-spinal dumbbell-shaped neurilemmoma may be a cervical mass and inconspicuous compressive spine cord. Analysis is essentially devoted to the radicality of tumor resection, nerve root preservation, relation to the vertebral artery, and compromise of spinal stability.The surgical resection of dumbbell-shaped cervical spinal neurilemmoma can pose a formidable challenge.

[Clinical application of heterogeneous acellular dermal matrix in the surgical treatment of oral submucous fibrosis].

PURPOSE: The aim of this study was to evaluate the clinical effect of heterogeneous acellular dermal matrix in the surgical treatment of advanced oral submucous fibrosis (OSF). METHODS: There were eight patients who had undergone surgical treatment of trismus caused by OSF. Surgery was performed under general anaesthesia given through a nasoendotracheal tube using a fibreoptic bronchoscope. All the fibrous bands on the buccal mucosa were incised and bluntly dissected to stretch the mouth opening. Based on the defect, heterogeneous acellular dermal matrix graft was applied directly on the bilateral wounds. A tie-over dressing technique was used to hold the graft firmly to its bed.The sutures and dressing material were removed on the tenth to fourteenth day after the operation. All the patients were asked to stretch the mouth opening 3 times daily and were followed up for at least 6 months. A modality of medical treatment including multiple micronutrient supplements and steroid injection therapy were carried out if necessary. The changes in the interincisal distances (IDs) were analyzed in the preoperative, intraoperative, and postoperative stages. The data was analyzed with SPSS16.0 software package for one-way ANOVA. RESULTS: The overall success rate was 100% without any or only partial graft loss. There were no immunologic reactions or significant complications.The mean preoperative, intraoperative, and final follow-up interincisal distances were 12.04, 35.46, and 29.33 mm, respectively. Evaluation of the changes in the IDs revealed statistically significant differences between the values recorded at the different stages.(P<0.05). CONCLUSIONS: Heterogeneous acellular dermal matrix may be a valuable biomaterial for repairing oral mucosal defects after surgery on the fibrous bands in patients with advanced OSF through covering and protecting wound surface early,which shortens the healing time of wound, decreases relapse of fibrosis and improve the restricted mouth opening.

[Reconstruction of oral and maxillofacial defects using free anterolateral thigh flaps in patients with malignant tumors].

PURPOSE: To explore the value of free anterolateral thigh flaps in the reconstruction of oral and maxillofacial defects following radical resection of malignant tumors. METHODS: Seventy-six cases of oral and maxillofacial malignant tumor from December 2007 to June 2009, including 32 tongue carcinomas, 16 buccal carcinomas, 10 carcinomas of floor of mouth, 9 gingival carcinomas, 8 oropharyngeal carcinomas and 1 skin carcinoma, underwent radical resection. Free anterolateral thigh flaps were used to reconstruct the defects. The postoperative effect and flap success rate were evaluated. RESULTS: Among 76 cases, 74 flaps survived completely with satisfied configuration, only 2 flaps had complete necrosis. The survival rate was 97.3%. No complications were observed in the donor site. CONCLUSIONS: The free anterolateral thigh flap is an ideal choice for reconstruction of oral and maxillofacial defects, as it has many advantages such as reliable blood supply, large size available, and little donor site morbidity.