Submental Island Flap After Prior Contralateral Neck Dissection: A Case Series and Technical Considerations

Objectives: The submental island flap is a dependable workhorse in head and neck reconstruction. However, the viability of this flap has not been established for oral cavity reconstruction when a contralateral neck dissection has already been performed in an earlier surgical setting. The aim of this study is to highlight technical considerations and outcomes of this approach with a small case series. Methods: Three cases of oral cavity reconstruction with a submental island flap elevated in the context of a prior contralateral neck dissection are presented. Results: In all cases, a doppler was used to identify the maintenance of the submental perforator in the neck opposite the previous neck dissection. In 2 cases, level IA was included within the dissection field of the previous neck dissection. Additionally, the old neck scar was included within the skin paddle of the submental island flap in 2 cases. In all cases, excellent healing of the flap was observed without partial or complete loss. Conclusions: The submental island flap appears to be a reliable reconstruction when a previous contralateral neck dissection has been performed, even when level IA was included in the prior dissection.

Orocutaneous Fistula After Oral Cavity Resection and Reconstruction: Systematic Review and Meta-Analysis

Objective: Orocutaneous fistula (OCF) after reconstruction for oral cavity resection can lead to prolonged hospitalization and adjuvant treatment delay. Few studies have examined factors leading to OCF after oral cavity resection. Primary objective: evaluate overall incidence and factors associated with OCF after oral cavity reconstruction. Data Sources: Scopus 1960—database was searched for terms: “orocutaneous fistula,” “oro cutaneous fistula,” “oral cutaneous fistula,” “orocervical fistula,” “oral cavity salivary fistula.” Review Methods: English language studies with >5 patients undergoing reconstruction after oral cavity cancer resection were included. About 1057 records initially screened; 214 full texts assessed; 78 full-texts included. PRISMA guidelines were followed, and MINORS criteria used to assess risk of bias. Data were pooled using random-effects model. Primary outcome was OCF incidence. Meta-analysis to determine the effect of preoperative radiation on OCF conducted on 12 eligible studies. Pre-collection hypothesis was that prior radiation therapy is associated with increased OCF incidence. Post-collection analyses: free versus pedicled flaps; mandible-sparing versus segmental mandibulectomy. Results: Seventy-eight studies were included in meta-analysis of overall OCF incidence. Pooled effect size showed overall incidence of OCF to be 7.71% (95% CI, 6.28%-9.13%) among 5400 patients. Meta-analysis of preoperative radiation therapy on OCF showed a pooled odds ratio of 1.68 (95% CI, 0.93-3.06). OCF incidence was similar between patients undergoing free versus pedicled reconstruction, or segmental mandibulectomy versus mandible-sparing resection. Conclusion: Orocutaneous fistula after oral cavity resection has significant incidence and clinical impact. Risk of OCF persists despite advances in reconstructive options; there is a trend toward higher risk after prior radiation.

Conversion of an oral to nasal intubation in difficult nasal anatomy patients: two case reports

Background Nasal intubation is indispensable for some cases that require intraoral surgical access, and the fiberoptic bronchoscope is the best tool for difficult airways. However, fiberoptic bronchoscopy is not always possible in cases with altered pharyngeal anatomy. Case presentation In this report, we introduce a novel technique for retrograde endotracheal oral-to-nasal conversion with an ordinary endotracheal tube exchange catheter. A 49-year-old male with a fractured mandible angle and symphysis was scheduled to undergo mandible reconstruction. Secondly, a 45-year-old male who had a bone defect in the mandible angle and ramus was scheduled for mandible and oral cavity reconstruction. We chose to intubate orally first and successfully converted the endotracheal tube from oral to nasal retrogressively using a tube exchange catheter. Conclusions Our simple and safe technique, which use a tube exchange catheter retrogressively, provides an alternative method for a difficult airway in which the fiberscope is not helpful.

Comparison of Aesthetic and Functional Outcomes of Microvascular Reconstruction with Other Forms of Reconstruction in Oral Cavity Malignancies

BACKGROUND Surgical resection is the main stay treatment in oral cancer. Different techniques were used by the surgeons for reconstruction of the normal anatomy. With these, a study was conducted to evaluate the outcome and quality of life in terms of conventional forms of reconstruction and functional outcome in both genders for oral cavity reconstruction. METHODS It was a hospital based non randomized study, conducted in the department of surgical oncology, Vydehi Institute of Medical Sciences and research centre, Bangalore from January 2017 to June 2018. Individuals aged 20 – 70 years with confirmed oral carcinoma were included; poor vascular supply of donor area, distant metastasis proved by chest X ray or abdominal ultrasound were excluded. Pre-structured proforma was used to collect the baseline data. ANOVA tests were used. P <0.05 was considered statistically significant. RESULTS Majority (27.7 %) were in the age group 51 to 60 years and the male to female ratio was 0.56. Statistically, there was no significant association between gender and type of flaps. 60 % had carcinoma of left buccal mucosa and 40 % had right side carcinoma, statistically there was no significant difference. The mean number of nodes was 20.85 ± 9.52. Statistically, there was no significant association between type of flaps and number of lymph nodes. CONCLUSIONS PMMC flap reconstruction is reliable and an affordable procedure with high success rate in achieving treatment goals. However, studies on large sample size for long term is required. KEYWORDS Oral Carcinoma, Microvascular Techniques, Local Flaps, Regional Flaps

REVISITING AN OLD TECHNIQUE FOR ORAL CAVITY RECONSTRUCTION USING MASSETER FLAP: AN INSTITUTIONAL EXPERIENCE OF 50 BUCCAL MUCOSA CANCER PATIENTS

Cancer of the posterior part of oral cavity are often diagnosed at an advanced stage. Although microsurgery and free flaps have better results, the use of local and regional flaps remains an easier, feasible and faster option for reconstruction. We have done a retrospective analysis of 50 patients who underwent, a masseter flap at our institution in our study along with its 6 months follow up and outcomes. This technique offers a quick and reliable method for repairing oral cavity defects in a selected few cases. The masseter flap has an advantage, as it is technically easy, pliable for posterior defects and no significant donor site morbidity while its drawbacks are its limited mobility and small posterior defect alone coverage. It may provide a simple and effective solution in a difficult situation in selective cases.