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PD.231 Locoregional flaps in orofacial reconstruction
Reconstruction 4 IP0.2291 Analysis of the functional and aesthetic results of the reconstruction of the lower lip defects after malignant tumor resection A. Bucur, T. Nita, I. Nicolescu, O. Dinca, D. Slavescu.
Department of Oral and Maxdlofactat Surgery, Unwerstty of Medtcme and Pharmacy Carol Daotla, BucharesL Romama Introduction: For the reconstruction & t h e lip, there is a series
of parameters to be considered: the intercomlssural distance, the nlaxilnum opening of tile mouth, tile depth of tile labial and buccal sulcus, tile hp senslblhty and the perloral nmscle strength. Tile aml of tile study is to compare tile functional and aesthetic results of different techniques of reconstmction of the lower lip after mahgnant tumor resection. Materials and Methods: A number of 27 cases with paramedian, stage I (cT1NOM0) mahgnant tumors of tile lower hp were included m tile study. Tile reconstruction techniques allalyzed and conlpared were Karapandzlc, Johanson and CanlflleBernard. Results: The Karapandzic technique has the advantage to rebuild the continuity of the orbmcularis otis muscle. The Johanson technique gave good results for tile inajorlty of these slnall turnors, with an indication of tile non-smletrlcal variation of tile tectmlque for file paramedian defects. Tile Canaille-Bernard techmque can be performed mallaterally or bilaterally, for lesions affechng the labial comlssure reclusive, with acceptable functional and aesthetic resuRs. Conclusion: These three tectilnques are tile most useful for smaller defects of the lower lip, with both advantages and disadvantages for each one of them.
IPD.•
Functional and aesthetic outcome of reconstruction of orofacial defects involving the lip(s) after resection of orofacial malignancies
A. Denewer, O. Hussem. Mansoura Umvers~ty Oncology
Center, A/Iansoura Facult.v of ~Iedtcme, Mansour~ Egypt Introduction: Squamous cell carcinoma of the upper aerodi-
gestave track as a predotunaant problem m our pataent populatlon clue to occupataonal and socaoeconomlc factors. Tile disease usually presents Ill a relatively advanced stage. Patient comphance, lack of technical l~acllltles and poor economic supplies decreases the utlhty and effecacy of radiotherapeutic management. Surgery could be curative as the biological behavaour of these cancers as usually locoregaonally lnvaslve. Here we discuss the interplaying oncologlc, furlctlonal and aesthetic challenges affecting reconstruction of the resulting postresectlonal defects. Materials and Methods: The study reviews one-hmadred twelve patients with mvaslve tumors at or extending to the hp(s). Tumor ranged from T2(43), T3(56) and T4(13). Nodal state was No m80, N1 m 29 and N2 ill three cases. Tile tectmlque used for hp reconstruction was: a. Unilateral or bilateral depressor angull orls flap for isolated hp defect (n=58); b. Pectorahs major myocutaneous pedicled flap for clam or other facml defects revolving the lip together with a tongue flap for mucosal reconstruction (n = 39); c. Balateral depressor anguh orls plus local cervical rotational flap for chill defects (n = 3); d. Myo-osseous (stemocleidomastoid-clavicular) flap for concomltant mandibular defects (n = 12). Results: Overall survival, disease free survival and local recurrence rate are presented. Aesthetic and functional results are evaluated regarding appearance, oral incompetence, dis-
137
abling microstoma and eating difficulties. Depressor anguli otis reconstruction allowed fimctioning static and dynamic oral fimction in all cases in contrast to the pectoralls major flap. There were 18 cases of oral incompetence (46.1%), nine cases of speech difficulty (23%) and five patients with poor cosmetic appearance Wlthm tile second group. Total flap loss not encountered. Partial flap loss affected thirteen depressor ang-uli flaps (21.3%) and sLx pectoral flaps (15.3%). Conclusion: We recommend reconstructing major hp defect with innervated myocutaneous flap from the facial musculature that can protect the patient from the mcapacitatmg symptoms of oral sphincter discontmulty.
•
Locoregional flaps in orofacial reconstruction
K. Ahme& B. Hazarlka. Dr B Borooah Cancer Instttute, India Introduction: Most head and neck cancers mandate major exttrpatave surgery. Prunary closure of the resultant defects is at tilnes leasable, but larger defects reqmre reconstruction, posing a challenge to the surgeon's skills. Local flaps often give very satisfactory results comparable to more soptustlcated techmques. Materials and Methods: From January 1997 to June 2004, a total of 93 pataents underwent reconstruction with local flaps. Tiae tongue flap (38 cases) and the naso-labaal flap (31 cases) formed the bulk of these procedures. Faclo-cervlco-pectoral (9), forehead (median-4 and lateral 5), scalp (3), N-lobed (2) and rhomboid (1) flaps completed the hst. Results: There were Olfly 3 total failures with flap necrosis. Wound mfectaon (3), flap dehascence (3), oro-cutaneous fistula (2) mad trlsmus (2) were other comphcatlons encountered. Overall results were satisfactory. Conclusion: Local flaps are cosmetically and functlonaUy acceptable. They requtre no special training and/or IlffrastmcCure and provide a versatile armamentarlum for the surgeon. Prevaous local trradiataon may preclude the use of local flaps. Every head and neck and oral surgeon should develop a basic know-how and expertise m the use of local flaps.
•D.•
Myomucosal buccal flap with anterior vascularisation in reconstruction of intraoral defects P. Radovlc, D. Kraslc, N. BUrlC, Z. Peslc. Department of 291axtllofactal Sw'ger3; Stomatology dmtc of Nts, Serbta and Montenegro. Yugoslavm Introduction: Tendency of modern head and neck reconstructive surgery is reconstruction of tissue defects with same or sumlar tissue. Special proNem are tissue defects m tile oral
cavity. and Methods: In Departrnent for maxfllofaclal surgery of Stomatology clinic NIS, lll period 2000-2003. 42 patients with mtraoral tlssile defects was treated m sense of reconstruction of defects with buccal myomucosal arterml flap with anterior vascularlsahon on facml artery. At 29 (69.04%) patients mtraoral tissue defect are begin after tumour resection, 8 (19.04°,o) patients was with oroantral fistulas after teeth extraction. At 5 (11.92%) patients this flap was apply for closing of extensive oroantral COlimmnicatlon after ablation of Rlmours. Results: It was described surgical tehnlc o f buccal nlyomucosal arterial flap forming also flap intersection into tile tissue defect. Dlscution was about caracterstlcs, as of advantages or flap deficiency. Results are compared with literature data. Materials
Department of Oral and Maxdlofactat Surgery, Unwerstty of Medtcme and Pharmacy Carol Daotla, BucharesL Romama Introduction: For the reconstruction & t h e lip, there is a series
of parameters to be considered: the intercomlssural distance, the nlaxilnum opening of tile mouth, tile depth of tile labial and buccal sulcus, tile hp senslblhty and the perloral nmscle strength. Tile aml of tile study is to compare tile functional and aesthetic results of different techniques of reconstmction of the lower lip after mahgnant tumor resection. Materials and Methods: A number of 27 cases with paramedian, stage I (cT1NOM0) mahgnant tumors of tile lower hp were included m tile study. Tile reconstruction techniques allalyzed and conlpared were Karapandzlc, Johanson and CanlflleBernard. Results: The Karapandzic technique has the advantage to rebuild the continuity of the orbmcularis otis muscle. The Johanson technique gave good results for tile inajorlty of these slnall turnors, with an indication of tile non-smletrlcal variation of tile tectmlque for file paramedian defects. Tile Canaille-Bernard techmque can be performed mallaterally or bilaterally, for lesions affechng the labial comlssure reclusive, with acceptable functional and aesthetic resuRs. Conclusion: These three tectilnques are tile most useful for smaller defects of the lower lip, with both advantages and disadvantages for each one of them.
IPD.•
Functional and aesthetic outcome of reconstruction of orofacial defects involving the lip(s) after resection of orofacial malignancies
A. Denewer, O. Hussem. Mansoura Umvers~ty Oncology
Center, A/Iansoura Facult.v of ~Iedtcme, Mansour~ Egypt Introduction: Squamous cell carcinoma of the upper aerodi-
gestave track as a predotunaant problem m our pataent populatlon clue to occupataonal and socaoeconomlc factors. Tile disease usually presents Ill a relatively advanced stage. Patient comphance, lack of technical l~acllltles and poor economic supplies decreases the utlhty and effecacy of radiotherapeutic management. Surgery could be curative as the biological behavaour of these cancers as usually locoregaonally lnvaslve. Here we discuss the interplaying oncologlc, furlctlonal and aesthetic challenges affecting reconstruction of the resulting postresectlonal defects. Materials and Methods: The study reviews one-hmadred twelve patients with mvaslve tumors at or extending to the hp(s). Tumor ranged from T2(43), T3(56) and T4(13). Nodal state was No m80, N1 m 29 and N2 ill three cases. Tile tectmlque used for hp reconstruction was: a. Unilateral or bilateral depressor angull orls flap for isolated hp defect (n=58); b. Pectorahs major myocutaneous pedicled flap for clam or other facml defects revolving the lip together with a tongue flap for mucosal reconstruction (n = 39); c. Balateral depressor anguh orls plus local cervical rotational flap for chill defects (n = 3); d. Myo-osseous (stemocleidomastoid-clavicular) flap for concomltant mandibular defects (n = 12). Results: Overall survival, disease free survival and local recurrence rate are presented. Aesthetic and functional results are evaluated regarding appearance, oral incompetence, dis-
137
abling microstoma and eating difficulties. Depressor anguli otis reconstruction allowed fimctioning static and dynamic oral fimction in all cases in contrast to the pectoralls major flap. There were 18 cases of oral incompetence (46.1%), nine cases of speech difficulty (23%) and five patients with poor cosmetic appearance Wlthm tile second group. Total flap loss not encountered. Partial flap loss affected thirteen depressor ang-uli flaps (21.3%) and sLx pectoral flaps (15.3%). Conclusion: We recommend reconstructing major hp defect with innervated myocutaneous flap from the facial musculature that can protect the patient from the mcapacitatmg symptoms of oral sphincter discontmulty.
•
Locoregional flaps in orofacial reconstruction
K. Ahme& B. Hazarlka. Dr B Borooah Cancer Instttute, India Introduction: Most head and neck cancers mandate major exttrpatave surgery. Prunary closure of the resultant defects is at tilnes leasable, but larger defects reqmre reconstruction, posing a challenge to the surgeon's skills. Local flaps often give very satisfactory results comparable to more soptustlcated techmques. Materials and Methods: From January 1997 to June 2004, a total of 93 pataents underwent reconstruction with local flaps. Tiae tongue flap (38 cases) and the naso-labaal flap (31 cases) formed the bulk of these procedures. Faclo-cervlco-pectoral (9), forehead (median-4 and lateral 5), scalp (3), N-lobed (2) and rhomboid (1) flaps completed the hst. Results: There were Olfly 3 total failures with flap necrosis. Wound mfectaon (3), flap dehascence (3), oro-cutaneous fistula (2) mad trlsmus (2) were other comphcatlons encountered. Overall results were satisfactory. Conclusion: Local flaps are cosmetically and functlonaUy acceptable. They requtre no special training and/or IlffrastmcCure and provide a versatile armamentarlum for the surgeon. Prevaous local trradiataon may preclude the use of local flaps. Every head and neck and oral surgeon should develop a basic know-how and expertise m the use of local flaps.
•D.•
Myomucosal buccal flap with anterior vascularisation in reconstruction of intraoral defects P. Radovlc, D. Kraslc, N. BUrlC, Z. Peslc. Department of 291axtllofactal Sw'ger3; Stomatology dmtc of Nts, Serbta and Montenegro. Yugoslavm Introduction: Tendency of modern head and neck reconstructive surgery is reconstruction of tissue defects with same or sumlar tissue. Special proNem are tissue defects m tile oral
cavity. and Methods: In Departrnent for maxfllofaclal surgery of Stomatology clinic NIS, lll period 2000-2003. 42 patients with mtraoral tlssile defects was treated m sense of reconstruction of defects with buccal myomucosal arterml flap with anterior vascularlsahon on facml artery. At 29 (69.04%) patients mtraoral tissue defect are begin after tumour resection, 8 (19.04°,o) patients was with oroantral fistulas after teeth extraction. At 5 (11.92%) patients this flap was apply for closing of extensive oroantral COlimmnicatlon after ablation of Rlmours. Results: It was described surgical tehnlc o f buccal nlyomucosal arterial flap forming also flap intersection into tile tissue defect. Dlscution was about caracterstlcs, as of advantages or flap deficiency. Results are compared with literature data. Materials