Is submental flap safe for the oncological reconstruction of the oral cavity?

AIM: The reconstruction of oral defects after oncological surgery is not an easy task for head and neck surgeons. The main aim of this work is to evaluate the functionality, viability and safety of submental flap for oral reconstruction. MATERIALS AND METHOD: We analyzed the records of patients diagnosed with oral and oropharyngeal SCC and reconstructed with the use of submental flap in Virgen de las Nieves University Hospital of Granada (Spain) from 2014 and 2015. Nine patients were found. Specific features such as age, sites of occurrence, sex distribution, T stage at diagnosis, nodal involvement, functionality of reconstruction and local and regional failure were determined. RESULTS: The male/female ratio was 8:1. The average age of the patients was 59.6 years (range: 42-75). Tumor locations were base of the tongue (n2), lateral edge of the tongue (n4), floor of the mouth (n2) and buccal mucosa (n1). Six tumors were classified as a T2 tumor and 3 as T3. No major complications were evidenced during the immediate postoperative period. Moreover, all patients showed excellent tissue coverage with acceptable aesthetic and functional outcomes. However, 1 patient showed partial epithelial loss of the skin paleta. Finally, the recurrence rate of disease was 44,4%. Four of 9 patients experienced a local (1/9) or cervical relapse (3/9). DISCUSSION: Submental flap might offer great aesthetic and functional results in oral reconstruction. However, the recurrence rate of disease was too high in our sample. From our point of view, submental flap should be carefully indicated in oncological reconstruction, especially in case of suspicion of lymph node involvement at level Ib.

Oral and oropharyngeal squamous cell carcinoma in young adults: A retrospective study in Granada University Hospital.

BACKGROUND: This study aims to evaluate and analyze the clinical features and outcomes of oral and oropharyngeal squamous cell carcinoma (SCC) in patients < 45-years old in our center. MATERIAL AND METHODS: A retrospective analysis was conducted using the records of patients diagnosed with oral and oropharyngeal SCC between 1998 and 2011 in the University Hospital of Granada (Spain). The analysis identified 33 patients with oral and oropharyngeal SCC with an age of <45 years. Moreover, during the years studied, a further 472 patients were diagnosed with oral and oropharyngeal SCC in our center. Thus, 100 SCC patients with an age of >45 years were randomly selected from the same database. A retrospective analysis was conducted to determine specific features including sites of occurrence, risk factors, sex distribution, socio-economic status, T stage at diagnosis, nodal involvement, degree of tumor differentiation, locoregional failure and overall survival at 5 years was. Further, the results of both groups were compared. RESULTS: The male-female ratio was 1.2:1 in the group of young adults and 2.03:1 in the group of patients with an age of >45 years. No significant differences were found in terms of site, nodal involvement, locoregional failure, and overall survival. However, there were statistically significant differences between the two groups in terms of features such as risk factors, socio-economic status, T stage at diagnosis, and degree of tumor differentiation. The overall 5-year survival rate was 62% for patients >45 years old, whilst for the group of young adults this rate was 48.4% (p= 0.17). CONCLUSIONS: The poor association between the common risk factors and oral and oropharyngeal cancers in young adults suggests that other pathogenic mechanisms should be investigated. For young patients, the data show evidence of poorer outcomes in terms of overall survival (p=0.17), and locoregional failure (p=0.23). Nevertheless, the literature shows that the results in this field are particularly inconsistent, and further research is therefore needed to provide more in-depth knowledge of the disease in this age group.

Colgajo libre osteocutáneo escapular en el tratamiento diferido de herida por arma de fuego / Scapular osteocutaneous free flap in the deferred treatment of firearm wounds

Las heridas por arma de fuego de velocidad alta o intermedia, provocanimportantes pérdidas de tejido óseo y blando. El tratamiento diferido de estoscasos (tratamiento reconstructivo) requiere el aporte de tejido sano de regionesdistantes mediante técnicas microquirúrgicas en la mayoría de las ocasiones. Exponemosla utilidad del colgajo osteocutáneo escapular(COE) para la reconstrucciónde defectos óseos mandibulares laterales con amplio defecto cutáneomucoso. Citamosdetalles técnicos de la realización del colgajo ilustrados con la presentación deun caso clínico de un varón de 19 años con herida por arma de fuego en tercio inferiorde la región lateral izquierda. Pérdida ósea del cuerpo mandibular y cutánea dela mejilla y región yugal ipsilateral.El tratamiento inicial consistió en traqueotomía, desbridamiento de tejidos desvitalizados,ferulización dentaria, bloqueo intermaxilar, colocación de placa de reconstrucciónmandibular y colgajo de avance cervico-facial para cierre del defecto cutáneo.La necrosis del colgajo de avance cervicofacial produjo comunicación orofacial.La retracción cicatricial limitó la apertura oral a 0,8 cm. De forma diferida se procedióa colgajo osteomiocutáneo escapular-paraescapular del brazo izquierdo parareconstrución mandibular y de partes blandas intra y extraorales. Resultados satisfactoriosestética y funcionalmente. Complicaciones producidas: fístula salival, desinsercióndel brazo largo del tríceps, y dehiscencia de herida de zona donante escapularque necesitó intervención para cierre mediante colgajo local(AU)

Firearm wounds caused by high-velocity projectiles causeenormous losses of bone and soft tissue. The deferred treatment ofthese cases (delayed reconstruction) in most cases requires thetransfer of free tissue from other areas of the body. The use ofscapular and parascapular free flaps with scapular bone for thereconstruction of large lateral mandibular defects with extensivesoft-tissue avulsion is reported. The technical details of a free flapare offered with illustrations in the case report of a 19-year-old malewho was shot at close range in the lower third of the left lateralface. Avulsion of the left mandibular body and soft tissue occurredin the region from the cheek to the oral commissure. The initialtreatment was tracheostomy, cleaning of necrotic and devitalizedtissues, wiring of a mandible-to-maxilla arch bar and intermaxillaryfixation, rigid fixation with a reconstructive mandibular plate, anda regional cervical flap to close the skin wound. The cervical flapwas lost and a postoperative oral-cervical fistula appeared. Scarcontraction limited the mouth opening to 0.8 cm. In deferredtreatment, a scapular and parascapular free flap with scapular bonefrom the left shoulder was used to reconstruct the mandibular andintraoral-facial soft-tissue defects. The aesthetic and functionalresults were optimal. Some complications occurred: postoperativesalivary fistula, deinsertion of the long head of the brachial triceps,and scapular wound dehiscence, which will be closed surgically witha local flap(AU)

Melanoma mucoso de senos paranasales / Mucosal melanoma of the paranasal sinuses

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