Reconstruction of lateral through and through oro-mandibular defects following oncological resections

Bernardo Bianchi, Andrea Ferri, Silvano Ferrari, Chiara Copelli, Pietro Boni, Alessandro Baj, Enrico Sesenna

Research output: Contribution to journalArticle

Abstract

Background: Resections of oromandibular squamous cell carcinoma involving lateral mandible, oral cavity, and the skin, lead to composite oromandibular defects that can be approached in several ways depending on the extension of the bone defect, of the soft tissue and cutaneous resection, the patient's general status and the prognosis. Purpose of the study is to evaluate retrospectively functional and esthetic outcome obtained with different reconstructive technique employed. Methods: A retrospective evaluation of 42 patients has been performed. The study population consisted of 24 males (57.1%) and 18 females (42.9%), ranging in age from 25 to 81 years (mean, 62.6 years). The primary location of the tumor was the mandibular alveolar crest (18 cases), retromolar trigon (9), floor of the mouth (8), cheek (5), and oral commissure (2). For reconstruction a single free flap technique was used eight times; a double free flap technique, seven times; free and locoregional flap association, 25 times; and a single locoregional flap and two associated locoregional flaps, one time each. Postoperative follow-up ranged from 12 to 144 months. Final results were evaluated with regards to deglutition, speech, oral competence, and esthetic outcome. Results: When free bone-containing flaps or two free flaps technique were used, the functional results were better (normal diet, 67%-71%; good oral competence, 100%-71%; good or intelligible speech, 100%-86%). When free and locoregional flap association was chosen, the esthetic results were best (excellent, 76%; acceptable 24%; poor 0%). The worst results were obtained with the use of a single free soft tissue flap and with the use of single or double locoregional flap technique. Conclusion: Bone reconstruction of the lateral mandible is indicated whenever possible. In elderly or poor prognosis patients acceptable results can be achieved with free soft tissue flaps techniques. When the defect involves different structures of the oral cavity, the best results are provided by the association of two free flaps. Finally, the association of free and locoregional flaps is a good option for external coverage reconstruction.

Original languageEnglish
Pages (from-to)517-525
Number of pages9
JournalMicrosurgery
Volume30
Issue number7
DOIs
Publication statusPublished - Oct 2010

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Free Tissue Flaps
Esthetics
Mandible
Bone and Bones
Mental Competency
Mouth
Mouth Floor
Skin
Cheek
Deglutition
Squamous Cell Carcinoma
Diet

ASJC Scopus subject areas

  • Surgery

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Reconstruction of lateral through and through oro-mandibular defects following oncological resections. / Bianchi, Bernardo; Ferri, Andrea; Ferrari, Silvano; Copelli, Chiara; Boni, Pietro; Baj, Alessandro; Sesenna, Enrico.

In: Microsurgery, Vol. 30, No. 7, 10.2010, p. 517-525.

Research output: Contribution to journalArticle

Bianchi, Bernardo ; Ferri, Andrea ; Ferrari, Silvano ; Copelli, Chiara ; Boni, Pietro ; Baj, Alessandro ; Sesenna, Enrico. / Reconstruction of lateral through and through oro-mandibular defects following oncological resections. In: Microsurgery. 2010 ; Vol. 30, No. 7. pp. 517-525.
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abstract = "Background: Resections of oromandibular squamous cell carcinoma involving lateral mandible, oral cavity, and the skin, lead to composite oromandibular defects that can be approached in several ways depending on the extension of the bone defect, of the soft tissue and cutaneous resection, the patient's general status and the prognosis. Purpose of the study is to evaluate retrospectively functional and esthetic outcome obtained with different reconstructive technique employed. Methods: A retrospective evaluation of 42 patients has been performed. The study population consisted of 24 males (57.1{\%}) and 18 females (42.9{\%}), ranging in age from 25 to 81 years (mean, 62.6 years). The primary location of the tumor was the mandibular alveolar crest (18 cases), retromolar trigon (9), floor of the mouth (8), cheek (5), and oral commissure (2). For reconstruction a single free flap technique was used eight times; a double free flap technique, seven times; free and locoregional flap association, 25 times; and a single locoregional flap and two associated locoregional flaps, one time each. Postoperative follow-up ranged from 12 to 144 months. Final results were evaluated with regards to deglutition, speech, oral competence, and esthetic outcome. Results: When free bone-containing flaps or two free flaps technique were used, the functional results were better (normal diet, 67{\%}-71{\%}; good oral competence, 100{\%}-71{\%}; good or intelligible speech, 100{\%}-86{\%}). When free and locoregional flap association was chosen, the esthetic results were best (excellent, 76{\%}; acceptable 24{\%}; poor 0{\%}). The worst results were obtained with the use of a single free soft tissue flap and with the use of single or double locoregional flap technique. Conclusion: Bone reconstruction of the lateral mandible is indicated whenever possible. In elderly or poor prognosis patients acceptable results can be achieved with free soft tissue flaps techniques. When the defect involves different structures of the oral cavity, the best results are provided by the association of two free flaps. Finally, the association of free and locoregional flaps is a good option for external coverage reconstruction.",
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T1 - Reconstruction of lateral through and through oro-mandibular defects following oncological resections

AU - Bianchi, Bernardo

AU - Ferri, Andrea

AU - Ferrari, Silvano

AU - Copelli, Chiara

AU - Boni, Pietro

AU - Baj, Alessandro

AU - Sesenna, Enrico

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N2 - Background: Resections of oromandibular squamous cell carcinoma involving lateral mandible, oral cavity, and the skin, lead to composite oromandibular defects that can be approached in several ways depending on the extension of the bone defect, of the soft tissue and cutaneous resection, the patient's general status and the prognosis. Purpose of the study is to evaluate retrospectively functional and esthetic outcome obtained with different reconstructive technique employed. Methods: A retrospective evaluation of 42 patients has been performed. The study population consisted of 24 males (57.1%) and 18 females (42.9%), ranging in age from 25 to 81 years (mean, 62.6 years). The primary location of the tumor was the mandibular alveolar crest (18 cases), retromolar trigon (9), floor of the mouth (8), cheek (5), and oral commissure (2). For reconstruction a single free flap technique was used eight times; a double free flap technique, seven times; free and locoregional flap association, 25 times; and a single locoregional flap and two associated locoregional flaps, one time each. Postoperative follow-up ranged from 12 to 144 months. Final results were evaluated with regards to deglutition, speech, oral competence, and esthetic outcome. Results: When free bone-containing flaps or two free flaps technique were used, the functional results were better (normal diet, 67%-71%; good oral competence, 100%-71%; good or intelligible speech, 100%-86%). When free and locoregional flap association was chosen, the esthetic results were best (excellent, 76%; acceptable 24%; poor 0%). The worst results were obtained with the use of a single free soft tissue flap and with the use of single or double locoregional flap technique. Conclusion: Bone reconstruction of the lateral mandible is indicated whenever possible. In elderly or poor prognosis patients acceptable results can be achieved with free soft tissue flaps techniques. When the defect involves different structures of the oral cavity, the best results are provided by the association of two free flaps. Finally, the association of free and locoregional flaps is a good option for external coverage reconstruction.

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