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P.179 Reconstruction of the oral commissure aftercancer excision
Poster Sessions
200
the strategy of facial contour recovery with prosthesis after cancer abrasion. Materials and Methods: The patients consisted of 3 males and 2 females, who had three ophthalmos cancers, one malignant melanoma o f the nasal cavffy and one scalp skin cancer. We apphed prosthesis for the 2 types; a) patient was completely resected the cancer but was not compensated by ordinary plastic surgery (three ophthalmos cancers), b) paitent had residual cancer because of ats advancement (malignant melanoma of nasal cavity and scalp skin cancer Results: They were compensated for the defects of ophthalmos, nose, ear by the mid-facial, nasal, ear prosthesis. All of them were satisfied with the new Facial contour by this method. For the patients who had residual cancer, it was easy to assess the cancer growth. Conclusion: Special skills are needed to make an excellent prosthesis. However, at is possible to reproduce shapes, and useful for the improvement o f quahty of life after ablative surgery.
1 • 7 1headA and n t neck e rthigh odefects l flaps a t eforr areconstruction l
of
I-Y. Humlg, C.-M. Chen, C.-J. Huang, S.-L. Llarg C.-H. Chei~ C.-S. Lal, H.R. Chen. Department of oral maxdlofactal
surgery. Kaohstung Medical Umverszty. Tatwan Introduction: Tins artacle presents our clamcal experaence wafll head and neck reconstructaon using a free anterolateral thigh (ALT) flap and describes the morbldaty of the donor site. Materials and Methods: From October 2001 to October 2003, 20 free ATL flaps were transferred for reconstructing soft-tassue defects of the head and neck. The age and gender of the patients, the sate of the primary ~ m o r , tumor stage, and previous operative condition, types o f assocaated operation, results of flap transfer, donor sate morbidity, and c11mcal course were analyzed. Results: O f 20 cases, 19 free flaps were successfully performed. The success rate was 95%. The size of the ALT flaps ranged from 6 to 10 cm m wadth and 9 to 20 cm m length (54 to 200 cm" in area). Sixteen of the 20 donor sates were closed prmlaraly, whereas 4 cases requared a spllt-thlcl~iess skin graft to cover the donor sate. Complacataons and morbidity of the donor sate were ~rmimml. Conclusion: The ALT flap has some advantages over other free flaps, including a long pedacle wath a suatable daarneter for anastomoses, the avaalabalaty of different tassues with large amounts of skin, the ease of closing the donor sate, and the ablhty for 2 teams to stmultasieously perform the operation.
•
Total lower lip reconstruction, with local flaps, after tumor excision
V. ThomaldiS, K. Seretls, D. Tarnlolakls, A. Karpouzls, M. Lanibropoulou, N. Papadopoulos, I. Tsamis. Umverstty
Dtstrmt Hospztal of Alexandroupohs, Department of Oral and Maxtllofactal Surger); Alexandroupohs, Greece Introduction: Total lower hp reconstruction, as a result of ~-mor excision, constitutes a slgmficant problem because of the arnportasit role that hps play m furictlon and esthetic of the face. Various methods using local or distant flaps have been developed in an attempt to provide the most satisfactory solutaon. Materials and Methods: We present our experience by using cheek advancement flaps (modifications of Bernard's method) and bilateral Fan flaps, m total lower lap reconstructmn after turnor excision. According to Webster's modification o f the
original Bernard's operation, the total lower lip is excised as a quadrilateral segment from commissure to commissure. Horizontal incisions extend laterally from the commissure and from the base of the lower lip defect; they divide the orbicularis but maintain continuity of the buccmator and ats nerve supply. Four Burow's triangles, sffuated above and below the lateral end of the flaps are excised allowing both nmcosa from the upper lip to provide the new vermilion surface and the medial cheek advancement to form the new lip. W h e n a significant portion o f the skin of the chin is excised a triangnlar-shaped lower excision as preferred, as described by Shah, to facilitate closure. The fan flap is a method of transposing nasolabml tissue into the lower lap. The flap base is superior, and the lateral flap is rotated to close the defect. Bilateral fan flaps can reconstruct the whole lower lip and the vertmllon is supplied by a tongue flap. Results: The advantage o f these operations as the ability to reconstruct the whole lower lap m a single-stage procedure. Although the problems of the mlhally Bernard technique, tight lower lap with overhanging upper lap and a "permanent smile'" deforimty, have not been overcome thoroughly, the latest tectmlques enhance the final result. Conclusion: There as no ideal method for producing a whole, sensate, mobile lower hp to give normal competence to the mouth although the bilateral fan flap gives a shghtly better lower hp.
•
Reconstruction of the oral commissure after cancer excision
I. Tsarms, V. ThomaldiS, K. Seretls, D. Tarmolakls, D. Zografopoulos. Departmo~t of Oral and Maxtllofactal
Surger); Alexandroupohs Unwersl(v Dtstrlct Hospltal. AIexandroupohs. Greece I n t r o d u c t i o n : The reconstmctlon of oral conmnssure defects is dafflcult mad complex, both aesthetically and functaonally. The nomlal contralateral comlmssure remains for comparason with the reconstruction, even if asy~mnetry as common. Three methods have been proposed for defects o f the comn~ssure. Materials and Methods: We present our experience, m three cases, by using the Zasser and the Jackson tectmNues in the reconstruction of the conmalssure, after excision of squamous cell carcinoma o f the angle of the mouth. In all cases, defects were extended without local or distal metastases (T2NOM0). In the Zlsser tectmlque (1975) the tumor as excised as a crescent. Afterwards, spht-thlckness traangles are excased superiorly and mferaorly. According to the Jackson tectmaque (1985) two rhomboid flaps are rinsed and rotated to close the defect and form the commissure. These flaps may be consasted of eather skin only or skin and mucosa, if necessary. The tturd method, the Converse "over and out" flap (1977), involves taking a pedrcled upper hp swatch flap and moving at laterally instead o f into the lower hp. Results: One pahent experienced drooling and inadequate closure of the mouth. As a result a revision was requested. No other complication was noticed during the ammediate and further postoperative period. Conclusion: These methods are stall coaasldered to b e the most sahsfactory for the reconstructmn of the oral conmnssure which rarely looks perfect after at has been removed. However, pmcushlonmg of the flaps, occasaonal loss of competence at the oral angle or appearance of microstomia may be produced and a secondary operation is usually necessary.
200
the strategy of facial contour recovery with prosthesis after cancer abrasion. Materials and Methods: The patients consisted of 3 males and 2 females, who had three ophthalmos cancers, one malignant melanoma o f the nasal cavffy and one scalp skin cancer. We apphed prosthesis for the 2 types; a) patient was completely resected the cancer but was not compensated by ordinary plastic surgery (three ophthalmos cancers), b) paitent had residual cancer because of ats advancement (malignant melanoma of nasal cavity and scalp skin cancer Results: They were compensated for the defects of ophthalmos, nose, ear by the mid-facial, nasal, ear prosthesis. All of them were satisfied with the new Facial contour by this method. For the patients who had residual cancer, it was easy to assess the cancer growth. Conclusion: Special skills are needed to make an excellent prosthesis. However, at is possible to reproduce shapes, and useful for the improvement o f quahty of life after ablative surgery.
1 • 7 1headA and n t neck e rthigh odefects l flaps a t eforr areconstruction l
of
I-Y. Humlg, C.-M. Chen, C.-J. Huang, S.-L. Llarg C.-H. Chei~ C.-S. Lal, H.R. Chen. Department of oral maxdlofactal
surgery. Kaohstung Medical Umverszty. Tatwan Introduction: Tins artacle presents our clamcal experaence wafll head and neck reconstructaon using a free anterolateral thigh (ALT) flap and describes the morbldaty of the donor site. Materials and Methods: From October 2001 to October 2003, 20 free ATL flaps were transferred for reconstructing soft-tassue defects of the head and neck. The age and gender of the patients, the sate of the primary ~ m o r , tumor stage, and previous operative condition, types o f assocaated operation, results of flap transfer, donor sate morbidity, and c11mcal course were analyzed. Results: O f 20 cases, 19 free flaps were successfully performed. The success rate was 95%. The size of the ALT flaps ranged from 6 to 10 cm m wadth and 9 to 20 cm m length (54 to 200 cm" in area). Sixteen of the 20 donor sates were closed prmlaraly, whereas 4 cases requared a spllt-thlcl~iess skin graft to cover the donor sate. Complacataons and morbidity of the donor sate were ~rmimml. Conclusion: The ALT flap has some advantages over other free flaps, including a long pedacle wath a suatable daarneter for anastomoses, the avaalabalaty of different tassues with large amounts of skin, the ease of closing the donor sate, and the ablhty for 2 teams to stmultasieously perform the operation.
•
Total lower lip reconstruction, with local flaps, after tumor excision
V. ThomaldiS, K. Seretls, D. Tarnlolakls, A. Karpouzls, M. Lanibropoulou, N. Papadopoulos, I. Tsamis. Umverstty
Dtstrmt Hospztal of Alexandroupohs, Department of Oral and Maxtllofactal Surger); Alexandroupohs, Greece Introduction: Total lower hp reconstruction, as a result of ~-mor excision, constitutes a slgmficant problem because of the arnportasit role that hps play m furictlon and esthetic of the face. Various methods using local or distant flaps have been developed in an attempt to provide the most satisfactory solutaon. Materials and Methods: We present our experience by using cheek advancement flaps (modifications of Bernard's method) and bilateral Fan flaps, m total lower lap reconstructmn after turnor excision. According to Webster's modification o f the
original Bernard's operation, the total lower lip is excised as a quadrilateral segment from commissure to commissure. Horizontal incisions extend laterally from the commissure and from the base of the lower lip defect; they divide the orbicularis but maintain continuity of the buccmator and ats nerve supply. Four Burow's triangles, sffuated above and below the lateral end of the flaps are excised allowing both nmcosa from the upper lip to provide the new vermilion surface and the medial cheek advancement to form the new lip. W h e n a significant portion o f the skin of the chin is excised a triangnlar-shaped lower excision as preferred, as described by Shah, to facilitate closure. The fan flap is a method of transposing nasolabml tissue into the lower lap. The flap base is superior, and the lateral flap is rotated to close the defect. Bilateral fan flaps can reconstruct the whole lower lip and the vertmllon is supplied by a tongue flap. Results: The advantage o f these operations as the ability to reconstruct the whole lower lap m a single-stage procedure. Although the problems of the mlhally Bernard technique, tight lower lap with overhanging upper lap and a "permanent smile'" deforimty, have not been overcome thoroughly, the latest tectmlques enhance the final result. Conclusion: There as no ideal method for producing a whole, sensate, mobile lower hp to give normal competence to the mouth although the bilateral fan flap gives a shghtly better lower hp.
•
Reconstruction of the oral commissure after cancer excision
I. Tsarms, V. ThomaldiS, K. Seretls, D. Tarmolakls, D. Zografopoulos. Departmo~t of Oral and Maxtllofactal
Surger); Alexandroupohs Unwersl(v Dtstrlct Hospltal. AIexandroupohs. Greece I n t r o d u c t i o n : The reconstmctlon of oral conmnssure defects is dafflcult mad complex, both aesthetically and functaonally. The nomlal contralateral comlmssure remains for comparason with the reconstruction, even if asy~mnetry as common. Three methods have been proposed for defects o f the comn~ssure. Materials and Methods: We present our experience, m three cases, by using the Zasser and the Jackson tectmNues in the reconstruction of the conmalssure, after excision of squamous cell carcinoma o f the angle of the mouth. In all cases, defects were extended without local or distal metastases (T2NOM0). In the Zlsser tectmlque (1975) the tumor as excised as a crescent. Afterwards, spht-thlckness traangles are excased superiorly and mferaorly. According to the Jackson tectmaque (1985) two rhomboid flaps are rinsed and rotated to close the defect and form the commissure. These flaps may be consasted of eather skin only or skin and mucosa, if necessary. The tturd method, the Converse "over and out" flap (1977), involves taking a pedrcled upper hp swatch flap and moving at laterally instead o f into the lower hp. Results: One pahent experienced drooling and inadequate closure of the mouth. As a result a revision was requested. No other complication was noticed during the ammediate and further postoperative period. Conclusion: These methods are stall coaasldered to b e the most sahsfactory for the reconstructmn of the oral conmnssure which rarely looks perfect after at has been removed. However, pmcushlonmg of the flaps, occasaonal loss of competence at the oral angle or appearance of microstomia may be produced and a secondary operation is usually necessary.