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Current Options and Controversies in Reconstruction of the Oral Cavity

  • Ravi Sachidananda
  • S. Mark Taylor
Part of the Head and Neck Cancer Clinics book series (HNCC)

Abstract

Reconstruction of oral defects has always posed a challenge to the reconstructive surgeon. The ever-increasing complexity of the defects, the need for restoring form and function, and changing treatment philosophies have increased the complexity of reconstruction. Reconstructive options have evolved significantly over the past three decades. In the 1980s, pedicle flaps were the mainstay of reconstruction. However, with the introduction of free flaps, reconstructive options have increased. Technological advances and improved experience with free flaps have enhanced the success rate to 95–100 % [1, 2]. Refinements in flap insetting and advances in other related specialties have led to an overall better quality of life for the patient. This chapter summarizes the current reconstructive options and discusses the major controversies in oral reconstruction.

Keywords

Free Flap Pedicled Flap Skin Paddle Radial Forearm Flap Pectoralis Major Myocutaneous Flap 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Suh JD, Sercarz JA, Abemayor E, et al. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 2004;130:962–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Cordeiro PG, Disa JJ, Hidalgo DA, et al. Reconstruction of the mandible with osseous free flaps: A 10-year experience with 150 consecutive patients. Plast Reconstr Surg 1999;104:1314–20.CrossRefPubMedGoogle Scholar
  3. 3.
    McConnel FM, Pauloski BR, Logemann JA, et al. Functional results of primary closure vs flaps in oropharyngeal reconstruction: A prospective study of speech and swallowing. Arch Otolaryngol Head Neck Surg 1998;124:625–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Hsiao HT, Leu YS, Chang SH, et al. Swallowing function in patients who underwent hemiglossectomy: Comparison of primary closure and free radial forearm flap reconstruction with videofluoroscopy. Ann Plast Surg 2003;50:450–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Hsiao HT, Leu YS, Lin CC. Primary closure versus radial forearm flap reconstruction after hemiglossectomy: Functional assessment of swallowing and speech. Ann Plast Surg 2002;49:612–16.CrossRefPubMedGoogle Scholar
  6. 6.
    Schramm VL Jr, Myers EN. Skin grafts in oral cavity reconstruction. Arch Otolaryngol 1980;106:528–32.CrossRefPubMedGoogle Scholar
  7. 7.
    Girod DA, Sykes K, Jorgensen J, et al. Acellular dermis compared to skin grafts in oral cavity reconstruction. Laryngoscope 2009;119:2141–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Lazaridis N, Tilaveridis I, Karakasis D. Superiorly or inferiorly based ‘islanded’ nasolabial flap for buccal mucosa defects reconstruction. J Oral Maxillofac Surg 2008;66:7–15.CrossRefPubMedGoogle Scholar
  9. 9.
    al Khabori MJ, Natarajan B, Thomas M, et al. Naso-labial flap in the reconstruction of floor of the mouth defects. J Laryngol Otol 1993;107:320–3.CrossRefGoogle Scholar
  10. 10.
    Hofstra EI, Hofer SO, Nauta JM, et al. Oral functional outcome after intraoral reconstruction with nasolabial flaps. Br J Plast Surg 2004;57:150–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Burkey BB, Coleman JR Jr. Current concepts in oromandibular reconstruction. Otolaryngol Clin North Am 1997;30:607–30.PubMedGoogle Scholar
  12. 12.
    Wang HS, Shen JW, Ma DB, et al. The infrahyoid myocutaneous flap for reconstruction after resection of head and neck cancer. Cancer 1986;57:663–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Magrin J, Kowalski LP, Santo GE, et al. Infrahyoid myocutaneous flap in head and neck reconstruction. Head Neck 1993;15:522–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Dolivet G, Gangloff P, Sarini J, et al. Modification of the infra hyoid musculo-cutaneous flap. Eur J Surg Oncol 2005;31:294–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Ricard AS, Laurentjoye M, Faucher A, et al. 276 cases of horizontal infrahyoid myocutaneous flap. Rev Stomatol Chir Maxillofac 2009;110:135–7. Epub 2009 Apr 28. French.CrossRefPubMedGoogle Scholar
  16. 16.
    Ethier JL, Trites J, Taylor SM. Pectoralis major myofascial flap in head and neck reconstruction: Indications and outcomes. J Otolaryngol Head Neck Surg 2009;38:632–41.PubMedGoogle Scholar
  17. 17.
    Liu HL, Chan JY, Wei WI. The changing role of pectoralis major flap in head and neck reconstruction. Eur Arch Otorhinolaryngol 2010. Epub ahead of print.Google Scholar
  18. 18.
    Mehta S, Sarkar S, Kavarana N, et al. Complications of the pectoralis major myocutaneous flap in the oral cavity: A prospective evaluation of 220 cases. Plast Reconstr Surg 1996;98:31–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Shah JP, Haribhakti V, Loree TR, et al. Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg 1990;160:352–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Liu R, Gullane P, Brown D, et al. Pectoralis major myocutaneous pedicled flap in head and neck reconstruction: Retrospective review of indications and results in 244 consecutive cases at the Toronto General Hospital. J Otolaryngol 2001;30:34–40.CrossRefPubMedGoogle Scholar
  21. 21.
    Kasler M, Banhidy FG, Trizna Z. Experience with the modified pectoralis major myocutaneous flap. Arch Otolaryngol Head Neck Surg 1992;118:931–2.CrossRefPubMedGoogle Scholar
  22. 22.
    Uwiera T, Seikaly H, Rieger J, et al. Functional outcomes after hemiglossectomy and reconstruction with a bilobed radial forearm free flap. J Otolaryngol 2004;33:356–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Haughey BH, Taylor SM, Fuller D. Fasciocutaneous flap reconstruction of the tongue and floor of mouth: Outcomes and techniques. Arch Otolaryngol Head Neck Surg 2002;128:1388–95.CrossRefPubMedGoogle Scholar
  24. 24.
    Kuriakose MA, Loree TR, Spies A, et al. Sensate radial forearm free flaps in tongue reconstruction. Arch Otolaryngol Head Neck Surg 2001;127:1463–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002;109:2219–26.CrossRefPubMedGoogle Scholar
  26. 26.
    Song YG, Chen GZ, Song YL. The free thigh flap: A new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984;37:149–59.CrossRefPubMedGoogle Scholar
  27. 27.
    Mäkitie AA, Beasley NJ, Neligan PC, et al. Head and neck reconstruction with anterolateral thigh flap. Otolaryngol Head Neck Surg 2003;129:547–55.CrossRefPubMedGoogle Scholar
  28. 28.
    Chana JS, Wei FC. A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. Br J Plast Surg 2004;57:603–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Ali RS, Bluebond-Langner R, Rodriguez ED, et al. The versatility of the anterolateral thigh flap. Plast Reconstr Surg 2009;124 (6 Suppl):e395–407.CrossRefPubMedGoogle Scholar
  30. 30.
    Shpitzer T, Neligan PC, Gullane PJ, et al. Oromandibular reconstruction with the fibular free flap. Analysis of 50 consecutive flaps. Arch Otolaryngol Head Neck Surg 1997;123:939–44.CrossRefPubMedGoogle Scholar
  31. 31.
    Hidalgo DA, Pusic AL. Free-flap mandibular reconstruction: A 10-year follow-up study. Plast Reconstr Surg 2002;110:438–49; discussion 450–1.CrossRefPubMedGoogle Scholar
  32. 32.
    Takushima A, Harii K, Asato H, et al. Choice of osseous and osteocutaneous flaps for mandibular reconstruction. Int J Clin Oncol 2005;10:234–42.CrossRefPubMedGoogle Scholar
  33. 33.
    David DJ. Use of an innervated deltopectoral flap for intraoral reconstruction. Plast Reconstr Surg 1977;60:377–80.PubMedGoogle Scholar
  34. 34.
    Santamaria E, Wei FC, Chen IH, et al. Sensation recovery on innervated radial forearm flap for hemiglossectomy reconstruction by using different recipient nerves. Plast Reconstr Surg 1999;103:450–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Boyd B, Mulholland S, Gullane P, et al. Reinnervated lateral antebrachial cutaneous neurosome flaps in oral reconstruction: Are we making sense? Plast Reconstr Surg 1994;93:1350–9; discussion 1360–2.CrossRefPubMedGoogle Scholar
  36. 36.
    Kimata Y, Uchiyama K, Ebihara S, et al. Comparison of innervated and non-innervated free flaps in oral reconstruction. Plast Reconstr Surg 1999;104:1307–13.CrossRefPubMedGoogle Scholar
  37. 37.
    Kerawala CJ, Newlands C, Martin I. Spontaneous sensory recovery in non-innervated radial forearm flaps used for head and neck reconstruction. Int J Oral Maxillofac Surg 2006;35:714–17. Epub 2006 May 11.CrossRefPubMedGoogle Scholar
  38. 38.
    Loewen IJ, Boliek CA, Harris J, et al. Oral sensation and function: A comparison of patients with innervated radial forearm free flap reconstruction to healthy matched controls. Head Neck 2010;32:85–95.PubMedGoogle Scholar
  39. 39.
    Biglioli F, Liviero F, Frigerio A, et al. Function of the sensate free forearm flap after partial glossectomy. J Craniomaxillofac Surg 2006;34:332–9. Epub 2006 Jul 21.CrossRefPubMedGoogle Scholar
  40. 40.
    Gillespie CA, Kenan PD, Ferguson BJ. Hard palate reconstruction in maxillectomy. Laryngoscope 1986;96:443–4.CrossRefPubMedGoogle Scholar
  41. 41.
    Okay DJ, Genden E, Buchbinder D, et al. Prosthodontic guidelines for surgical reconstruction of the maxilla: A classification system of defects. J Prosthet Dent 2001;86:352–63.CrossRefPubMedGoogle Scholar
  42. 42.
    Rogers SN, Lowe D, McNally D, et al. Health-related quality of life after maxillectomy: A comparison between prosthetic obturation and free flap. J Oral Maxillofac Surg 2003;61:174–81.CrossRefPubMedGoogle Scholar
  43. 43.
    Genden EM, Okay D, Stepp MT, et al. Comparison of functional and quality-of-life outcomes in patients with and without palatomaxillary reconstruction: A preliminary report. Arch Otolaryngol Head Neck Surg 2003;129:775–80.CrossRefPubMedGoogle Scholar
  44. 44.
    Irish J, Sandhu N, Simpson C, et al. Quality of life in patients with maxillectomy prostheses. Head Neck 2009;31:813–21.CrossRefPubMedGoogle Scholar
  45. 45.
    Rieger JM, Wolfaardt JF, Jha N, et al. Maxillary obturators: The relationship between patient satisfaction and speech outcome. Head Neck 2003;25:895–903.CrossRefPubMedGoogle Scholar
  46. 46.
    Milenovic A, Virag M, Uglesic V, et al. The pectoralis major flap in head and neck reconstruction: First 500 patients. J Craniomaxillofac Surg 2006;34:340–3. Epub 2006 Jul 24.CrossRefPubMedGoogle Scholar
  47. 47.
    Mallet Y, El Bedoui S, Penel N, et al. The free vascularized flap and the pectoralis major pedicled flap options: Comparative results of reconstruction of the tongue. Oral Oncol 2009;45:1028–31. Epub 2009 Sep 30.CrossRefPubMedGoogle Scholar
  48. 48.
    Tsue TT, Desyatnikova SS, Deleyiannis FW, et al. Comparison of cost and function in reconstruction of the posterior oral cavity and oropharynx. Free vs pedicled soft tissue transfer. Arch Otolaryngol Head Neck Surg 1997;123:731–7.CrossRefPubMedGoogle Scholar
  49. 49.
    McCrory AL, Magnuson JS. Free tissue transfer versus pedicled flap in head and neck reconstruction. Laryngoscope 2002;112:2161–5.CrossRefPubMedGoogle Scholar
  50. 50.
    de Bree R, Reith R, Quak JJ, et al. Free radial forearm flap versus pectoralis major myocutaneous flap reconstruction of oral and oropharyngeal defects: A cost analysis. Clin Otolaryngol 2007;32:275–82.CrossRefPubMedGoogle Scholar
  51. 51.
    Funk GF, Karnell LH, Whitehead S, et al. Free tissue transfer versus pedicled flap cost in head and neck cancer. Otolaryngol Head Neck Surg 2002;127:205–12.CrossRefPubMedGoogle Scholar
  52. 52.
    Su WF, Hsia YJ, Chang YC, et al. Functional comparison after reconstruction with a radial forearm free flap or a pectoralis major flap for cancer of the tongue. Otolaryngol Head Neck Surg 2003;128:412–18.CrossRefPubMedGoogle Scholar
  53. 53.
    Chepeha DB, Annich G, Pynnonen MA, et al. Pectoralis major myocutaneous flap vs revascularized free tissue transfer: Complications, gastrostomy tube dependence, and hospitalization. Arch Otolaryngol Head Neck Surg 2004;130:181–6.CrossRefPubMedGoogle Scholar
  54. 54.
    Irish JC, Gullane PJ, Gilbert RW, et al. Primary mandibular reconstruction with the titanium hollow screw reconstruction plate: Evaluation of 51 cases. Plast Reconstr Surg 1995;96:93–9.CrossRefPubMedGoogle Scholar
  55. 55.
    Blackwell KE, Buchbinder D, Urken ML. Lateral mandibular reconstruction using soft-tissue free flaps and plates. Arch Otolaryngol Head Neck Surg 1996;122:672–8.CrossRefPubMedGoogle Scholar
  56. 56.
    Arden RL, Rachel JD, Marks SC, et al. Volume-length impact of lateral jaw resections on complication rates. Arch Otolaryngol Head Neck Surg 1999;125:68–72. PubMedGoogle Scholar
  57. 57.
    Blackwell KE, Lacombe V. The bridging lateral mandibular reconstruction plate revisited. Arch Otolaryngol Head Neck Surg 1999;125:988–93.CrossRefPubMedGoogle Scholar
  58. 58.
    Shpitzer T, Gullane PJ, Neligan PC, et al. The free vascularized flap and the flap plate options: Comparative results of reconstruction of lateral mandibular defects. Laryngoscope 2000;110:2056–60.CrossRefPubMedGoogle Scholar
  59. 59.
    Wei FC, Celik N, Yang WG, et al. Complications after reconstruction by plate and soft-tissue free flap in composite mandibular defects and secondary salvage reconstruction with osteocutaneous flap. Plast Reconstr Surg 2003;112:37–42.CrossRefPubMedGoogle Scholar
  60. 60.
    Head C, Alam D, Sercarz JA, et al. Microvascular flap reconstruction of the mandible: A comparison of bone grafts and bridging plates for restoration of mandibular continuity. Otolaryngol Head Neck Surg 2003;129:48–54.CrossRefPubMedGoogle Scholar
  61. 61.
    Poli T, Ferrari S, Bianchi B, et al. Primary oromandibular reconstruction using free flaps and thorp plates in cancer patients: A 5-year experience. Head Neck 2003;25:15–23.CrossRefPubMedGoogle Scholar
  62. 62.
    Okura M, Isomura ET, Iida S, et al. Long-term outcome and factors influencing bridging plates for mandibular reconstruction. Oral Oncol 2005;41:791–8.CrossRefPubMedGoogle Scholar
  63. 63.
    Chepeha DB, Teknos TN, Fung K, et al. Lateral oromandibular defect: When is it appropriate to use a bridging reconstruction plate combined with a soft tissue revascularized flap? Head Neck 2008;i30:709–17.Google Scholar
  64. 64.
    Coletti DP, Ord R, Liu X. Mandibular reconstruction and second generation locking reconstruction plates: Outcome of 110 patients. Int J Oral Maxillofac Surg 2009;38:960–3. Epub 2009 May 6.CrossRefPubMedGoogle Scholar

Copyright information

© The Author(s) 2012

Authors and Affiliations

  1. 1.Head & Neck Surgery and Microvascular ReconstructionQE2 HSC, VG SiteHalifaxCanada
  2. 2.Otolaryngology, Head & Neck Surgery, Facial Plastic and Reconstructive surgeryQE2 HSC, VG SiteHalifaxCanada

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