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P2.63. Treatment outcome of carcinoma of tongue with surgical excision and anterolateral thigh flap reconstruction: A single centre study
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182
Poster session II / Oral Oncology Supplement 3 (2009) 162–200
and a second malignancy in the lungs, there were constraints in the time, and in the health of the vascular tree. Other options were necessary, to reduce theatre time and to enable a single field procedure to facilitate recovery. Methods: The Temporalis Fascia, based on the branches of the temporal artery, was employed around a custom-shaped titanium plate bridging the zygomatic buttresses. Results: With follow-up of over a year at the time of writing, and excellent function and form, this pictoral record demonstrates a potential technique of reconstructing the region of the hard palate with a pedicled flap. Discussion: This technique of reconstruction provides an option in the reconstruction of the region of the hard palate. doi:10.1016/j.oos.2009.06.465
P2.62. Lateral arm free flap for oral tongue defect reconstruction A.J. Battoo, K. Thankappan, S. Chatni, M.A. Kuriakose, S. Iyer* Amrita Institute of Medical Sciences, Kochi, India Objective: Reconstruction of defects of anterior tongue has been reported to be best carried out with free tissue transfer. Radial forearm flap has been the choice for thesame. Lateral arm flap provides adequate bulk and has least donor site morbidity. However, it has been reported for reconstruction of floor of mouth defects. Objective of this study was to analyse the defects, flap details, donor site morbidity and functional outcome in oral tongue defects reconstructed by lateral arm flap. Methods: Retrospective review of case records of 46 consecutive patients who underwent lateral arm flap reconstruction of the oral tongue defects over a period of three years was done. The operative details and the perioperative problems were analysed. The aesthetic and functional results in the donor site as well as the reconstructed tongue was prospectively analysed in patients alive and disease free. A specially designed analysis tool was used to measure the speech outcome. Results: All patients where lateral arm flap was used had a defect of the oral tongue without the involvement of floor of mouth. The overall flap success rate has been 94% in this series, and the pedicle length averaged 6 cm. Either the facial or the superior thyroid artery was chosen as the recipient artery. The volume of the reconstructed tongue matched the defect in majority of the cases. Donor site was closed primarily with very good donor site scar as perceived by the surgeon as well as the patient. The speech and swallowing outcome were graded as very good in majority of the patients. Conclusions: Lateral arm flaps provide the adequate bulk and suitable tissue for reconstructing partial defects of tongue with minimal extension to the floor of the mouth. The pedicle length is adequate and good flap success rate can be achieved. The aesthetic and functional outcome at the donor as well as recipient site is excellent. doi:10.1016/j.oos.2009.06.466
P2.63. Treatment outcome of carcinoma of tongue with surgical excision and anterolateral thigh flap reconstruction: A single centre study Y.H. Ng* Kwong Wah Hospital, Hong Kong
Background: Soon after the development of anterolateral thigh (ALT) flap by Song, it becomes a popular flap for head and neck reconstruction. This paper mainly focuses on the clinical outcome of carcinoma of tongue treated with surgical excision and reconstruction by free ALT flap in our hospital. Method: There were 30 patients with carcinoma of tongue treated with surgical excision and free ALT flap reconstruction during the period of January 2003–January 2008 in our centre. Results: There were 17 male and 13 female patients with medial age of 65.5. Majority of carcinoma were located over the lateral side of the tongue with 36.7% over the right side and 53.3% over the left. The percentage of T1, T2 and T3 disease were 13.3%, 60% and 26.7%, respectively. 56.7% of them had lymph node metastasis and 23.3% had N1 disease and 20% had N2 disease. Operative complications included 13.3% had wound infection and collection. Among them, 50% required surgical drainage. Flap failure occurred in 6.7% and all of them required surgical debridement and pectoralis major muscle flap coverage. And 66.7% of patients required post-op adjuvant radiotherapy. The median disease free survival in the study series was 48 months and the 3-year survival rate is 60%. The mean follow up time was 23.5 months. Conclusion: The ALT flap for the reconstruction after glossectomy had an acceptable outcome in a local regional hospital in Hong Kong. doi:10.1016/j.oos.2009.06.467
P2.64. Surgical repair of large palatinal defects using tongue flaps H.-J. Hochstein*, A. Held Private Praxisclinic Thallwitz, Germany Communications between oral and nasal cavities may occur as sequelae of accidents Congenital malformations – persisting after multiple surgical procedures-and after Tumorsurgery. Multiple surgical techniques have been described for the closure of Such defects by single or staged operations. We have the tongue flap for this defects. Even large defects can be repaired by Combining a tongue flap with a pharyngeal flap. The advantages of an operative closure of such oronasal communications are: Improved articulation,a better base for prosthetic care, no nasal leakage and improved Social contact. doi:10.1016/j.oos.2009.06.468
P2.65. The anterolateral thigh flap fascial layer in pharyngeal reconstruction: Three layers for the price of two R. Anand*, S. Halsnad, P. Praveen, P. Jeynes, T. Martin, S. Parmar University Hospital Birmingham, United Kingdom Introductions: The anterolateral thigh flap (ALT) has been extensively described in pharyngeal reconstruction however like all other modalities of reconstruction fistula formation still occurs and can be anything up to 20%. This has been somewhat reduced in our unit with the use of the Montgomery salivary bypass tube for an extended time of six weeks. The authors felt that further reduction in fistula formation may be gained by raising a large cuff of fascia overlying the quadriceps to provide a third layer of closure and support at both the proximal and distal ends of the pharyngeal anastomosis.
182
Poster session II / Oral Oncology Supplement 3 (2009) 162–200
and a second malignancy in the lungs, there were constraints in the time, and in the health of the vascular tree. Other options were necessary, to reduce theatre time and to enable a single field procedure to facilitate recovery. Methods: The Temporalis Fascia, based on the branches of the temporal artery, was employed around a custom-shaped titanium plate bridging the zygomatic buttresses. Results: With follow-up of over a year at the time of writing, and excellent function and form, this pictoral record demonstrates a potential technique of reconstructing the region of the hard palate with a pedicled flap. Discussion: This technique of reconstruction provides an option in the reconstruction of the region of the hard palate. doi:10.1016/j.oos.2009.06.465
P2.62. Lateral arm free flap for oral tongue defect reconstruction A.J. Battoo, K. Thankappan, S. Chatni, M.A. Kuriakose, S. Iyer* Amrita Institute of Medical Sciences, Kochi, India Objective: Reconstruction of defects of anterior tongue has been reported to be best carried out with free tissue transfer. Radial forearm flap has been the choice for thesame. Lateral arm flap provides adequate bulk and has least donor site morbidity. However, it has been reported for reconstruction of floor of mouth defects. Objective of this study was to analyse the defects, flap details, donor site morbidity and functional outcome in oral tongue defects reconstructed by lateral arm flap. Methods: Retrospective review of case records of 46 consecutive patients who underwent lateral arm flap reconstruction of the oral tongue defects over a period of three years was done. The operative details and the perioperative problems were analysed. The aesthetic and functional results in the donor site as well as the reconstructed tongue was prospectively analysed in patients alive and disease free. A specially designed analysis tool was used to measure the speech outcome. Results: All patients where lateral arm flap was used had a defect of the oral tongue without the involvement of floor of mouth. The overall flap success rate has been 94% in this series, and the pedicle length averaged 6 cm. Either the facial or the superior thyroid artery was chosen as the recipient artery. The volume of the reconstructed tongue matched the defect in majority of the cases. Donor site was closed primarily with very good donor site scar as perceived by the surgeon as well as the patient. The speech and swallowing outcome were graded as very good in majority of the patients. Conclusions: Lateral arm flaps provide the adequate bulk and suitable tissue for reconstructing partial defects of tongue with minimal extension to the floor of the mouth. The pedicle length is adequate and good flap success rate can be achieved. The aesthetic and functional outcome at the donor as well as recipient site is excellent. doi:10.1016/j.oos.2009.06.466
P2.63. Treatment outcome of carcinoma of tongue with surgical excision and anterolateral thigh flap reconstruction: A single centre study Y.H. Ng* Kwong Wah Hospital, Hong Kong
Background: Soon after the development of anterolateral thigh (ALT) flap by Song, it becomes a popular flap for head and neck reconstruction. This paper mainly focuses on the clinical outcome of carcinoma of tongue treated with surgical excision and reconstruction by free ALT flap in our hospital. Method: There were 30 patients with carcinoma of tongue treated with surgical excision and free ALT flap reconstruction during the period of January 2003–January 2008 in our centre. Results: There were 17 male and 13 female patients with medial age of 65.5. Majority of carcinoma were located over the lateral side of the tongue with 36.7% over the right side and 53.3% over the left. The percentage of T1, T2 and T3 disease were 13.3%, 60% and 26.7%, respectively. 56.7% of them had lymph node metastasis and 23.3% had N1 disease and 20% had N2 disease. Operative complications included 13.3% had wound infection and collection. Among them, 50% required surgical drainage. Flap failure occurred in 6.7% and all of them required surgical debridement and pectoralis major muscle flap coverage. And 66.7% of patients required post-op adjuvant radiotherapy. The median disease free survival in the study series was 48 months and the 3-year survival rate is 60%. The mean follow up time was 23.5 months. Conclusion: The ALT flap for the reconstruction after glossectomy had an acceptable outcome in a local regional hospital in Hong Kong. doi:10.1016/j.oos.2009.06.467
P2.64. Surgical repair of large palatinal defects using tongue flaps H.-J. Hochstein*, A. Held Private Praxisclinic Thallwitz, Germany Communications between oral and nasal cavities may occur as sequelae of accidents Congenital malformations – persisting after multiple surgical procedures-and after Tumorsurgery. Multiple surgical techniques have been described for the closure of Such defects by single or staged operations. We have the tongue flap for this defects. Even large defects can be repaired by Combining a tongue flap with a pharyngeal flap. The advantages of an operative closure of such oronasal communications are: Improved articulation,a better base for prosthetic care, no nasal leakage and improved Social contact. doi:10.1016/j.oos.2009.06.468
P2.65. The anterolateral thigh flap fascial layer in pharyngeal reconstruction: Three layers for the price of two R. Anand*, S. Halsnad, P. Praveen, P. Jeynes, T. Martin, S. Parmar University Hospital Birmingham, United Kingdom Introductions: The anterolateral thigh flap (ALT) has been extensively described in pharyngeal reconstruction however like all other modalities of reconstruction fistula formation still occurs and can be anything up to 20%. This has been somewhat reduced in our unit with the use of the Montgomery salivary bypass tube for an extended time of six weeks. The authors felt that further reduction in fistula formation may be gained by raising a large cuff of fascia overlying the quadriceps to provide a third layer of closure and support at both the proximal and distal ends of the pharyngeal anastomosis.