Jan Akervall* and Natalie Gratsch
Department of Otolaryngology, St. Joseph Mercy Hospital, USAFulltext PDF
Objectives: The defects after resections of T2 and limited T4 tumors of the anterior floor of mouth and gingival are often reconstructed with free forearm flaps or bilateral nasolabial flaps. These techniques are often associated with impaired sensation and unpredictable scar formation both intra orally and at the donor site. Patients may experience symptoms such as dysphagia, dysarthria and donor site cosmetic problems. Therefore, we have developed a reconstructive alternative that allows for the reliable coverage of soft tissue and bone, preservation of local sensation and rapid recovery of oral functions. Study design: This is a prospective study of eight patients, six of which had T2 lesions of the anterior floor of mouth and two had T2 lesions of the gingiva. The defects measured 4 cm to 5 cm by 2.5 cm to 3 cm including partial mandibulectomy with up to nine teeth. Method: A local mucosal flap was raised from the inferior aspect of the tongue. Multiple holes were drilled in the exterior cortex of the mandibular defect. The flap was then pulled forward and anchored to these drill holes by 3-0 sutures. The anterior margin of the defect was also anchored to these drill holes to produce a water tight closure, allowing the lip to be independent of the mucosal flap. Results: The mucosal flap stretched and normalized into position within 2 weeks. After that seven of the eight patients had normal or minimally decreased tongue mobility and normal speech (one patient developed osteoradionecrosis after postoperative radiation). Fully normal sensation in the flap was experienced by six of the patients, with only two noting slight impairment. Swallowing capacity was normal or minimally affected. Discussion: This local bone anchored mucosal tongue flap has the advantage of short operating room time and hospitalization, only one surgeon is required, there is no donor site morbidity and rapid return of oral function. Conclusion: We propose this flap as a reconstructive alternative for defects up to the size of T2 and small T4 lesions of the anterior floor of mouth and gingiva.
Oral reconstruction; Regional flaps; Floor of mouth cancer; Gingival cancer; Donor site morbidity; Dysphagia; Dysarthria
kervall J, Gratsch N. Bone Anchored Mucosal Flap for Reconstruction of Floor of Mouth and Gingiva-Pilot Study. Am J Otolaryngol Head Neck Surg. 2019; 2(10): 1077.