Three-dimensional primary reconstruction of anterior mouth floor and ventral tongue using the 'trilobed' buccinator myomucosal island flap.

Three-dimensional reconstruction of the anterior mouth floor and ventral tongue after ablative surgery can be achieved using several techniques. The ideal reconstruction should be accomplished with the same or similar type of tissue, and cheek axial myomucosal flaps based on the branches of facial or internal maxillary arteries seem ideal for this purpose. From March 2005 to May 2007, 23 patients underwent cheek axial myomucosal flap reconstruction after oral cancer surgical ablation. Thanks to their thinness and pliability, these flaps were frequently shaped to obtain an accurate reconstruction. According to Whetzel's hypothesis, an intraoral flap designed to include the axial vessel of one area can safely carry the mucosa of a neighbouring vascular area. The authors describe a large buccinator myomucosal island flap based on the branches of the facial artery and formed in a trilobed shape in order to capture the adjacent buccal mucosal angiosome from the internal maxillary artery. The flap provided the correct anatomical oral reconstruction for the anterior mouth floor and ventral tongue. The function of the tongue, oral intake and mastication were not impaired. The trilobed buccinator myomucosal island flap is a suitable option for the three-dimensional reconstruction of the anterior mouth floor and ventral tongue.

Soft palate functional reconstruction with buccinator myomucosal island flaps.

Oropharyngeal reconstruction after ablative surgery is a challenge. The results of a retrospective study of 17 patients who underwent total or sub-total soft palate reconstruction with a buccinator myomucosal island flap, between 2008 and 2016, are reported herein. An analysis of flap type and size, harvesting time, and postoperative complications was performed. Patients underwent standardized tests to assess the recovery of sensitivity, deglutition, quality of life (QoL), and donor site morbidity, at >6 months after surgery or the end of adjuvant therapy, if performed. All flaps were transposed successfully. Only minor donor and recipient site complications occurred. The sensitivity assessment showed that touch, two-point discrimination, and pain sensations were recovered in all patients. Significant differences between the flap and native mucosa were reported for tactile (P=0.004), pain (P=0.001), and two-point discrimination (P=0.001) thresholds. The average deglutition score reported was 6.1/7, with only minimal complaints regarding deglutition. The QoL assessment showed high physical (24.6/28), social (25/28), emotional (19.1/24), and functional (24.6/28) scores. No major donor site complications were noted in any patient; the average donor site morbidity score was 8.1/9. Buccinator myomucosal island flaps represent a valuable functional oropharyngeal option for reconstruction, requiring a short operating time and presenting a low donor site morbidity rate.

Role of intra-operative sentinel lymph node biopsy in oral cavity and oropharynx squamous cell carcinoma: preliminary data.

In patients with squamous cell carcinoma of the oral cavity and oropharynx, the presence of latero-cervical lymph node metastases was found to be the most important of the better known prognostic factors. Still, today, the most reliable technique by which to detect the presence of lymph node metastases is surgery aimed at the dissection of the latero-cervical space; albeit, this surgical procedure has been shown to be an over-treatment in a large percentage of patients presenting squamous cell carcinoma, clinically, radiologically and histologically negative, at neck level. The technique of intra-operative biopsy of sentinel lymph node, routinely used in the staging and treatment of tumours with elective lymphatic involvement such as carcinoma of the breast and malignant cutaneous melanoma, has progressively caught the attention of head and neck surgeons in the most important referral centres in the world, and, indeed, its role has been hypothesised in the treatment of patients with squamous cell carcinoma of the oral cavity and oropharynx with clinically N0 neck. Preliminary results are reported, concerning the use of this intraoperative sentinel lymph node biopsy technique with double tracer in patients presenting squamous cell carcinoma originating in the mucosa of the upper air-digestive tract, clinically and radiologically free from disease at latero-cervical level.

Computer assisted dental rehabilitation in free flaps reconstructed jaws: one year follow-up of a prospective clinical study.

Continuity defects in bone after resection of the jaw may cause problems, and osseo-myocutaneous free flaps are the gold standard for their reconstruction. Implant-supported prosthetic rehabilitation is reliable with these microvascular options, although it is still a serious challenge. The aim of this prospective clinical study was to describe the advantages of implants restored according to a computer-assisted surgical protocol. A group of 10 consecutive patients (both sexes) had already been treated and followed up for at least 1 year after prosthetic loading. The NobelGuide protocol had to be modified to adapt the technique for these patients who had had reconstructions. A total of 56 fixtures were installed and, when possible, immediately loaded (overall survival of implants 95%). Every patient was given correct provisional prosthetic rehabilitation, which was most satisfactory as far as chewing, social functioning, and overall quality of life were concerned. Three-dimensional computed tomographic (CT) examination showed a mean (SD) marginal bone loss of 1.06 (0.5)mm. We used a modified technique of computer-assisted implant surgery in jaws that had been reconstructed with free flaps; from these preliminary findings this approach seems valid when it comes to function, improving prosthetic restoration, and aesthetics.