Locally advanced cheek carcinoma; radical surgery and reconstruction of though and through defects

Squamous cell carcinoma of the cheek is a locoregionally aggressive tumor. Radical resection may be curative in cases of large tumor without distant metastases. We reviewed forty eight consecutive cases of Sq.c.c. of the oral cavity to evaluate the feasibility and efficacy of the reconstructive method.

Forty eight cases of invasive Sq.c.c. affecting the cheek performed in Mansoura University, Surgical Oncology Department. From November 2001 to October 2004 were included. Twenty cafes presented primarily, and 28 were relapsing after previous surgery or radiotherapy. Tumors of T3 and T4 size were included. Radical excision with adequate safety margin followed by reconstruction was done in the same setting using: A- Double layered pectoralis major flap (n=30). B- Pectoralis major flap for external surface and tongue flap for mucosal lining (n=10). C- Pectoralis major flap plus free Latissmus dorsi flap (n=3). D- Latissmus dorsi flap plus tongue flap (n=5).

Nine cases (18.7%) had local and distant relapse after a median follow up period of 36 months. However, total flap loss was not encountered. There were partial loss of three tongue flaps, seven pectoralis flaps corrected with debridement and reapproximation. Two patients had oral incompetence. Orocutaneous salivary fistula persistent more than three weeks occurred in eight patients. Functional outcome in terms of oral competence, sensibility, chewing movements was satisfactory in all but three cases.

Radical resection of extensive cheek carcinoma and reconstruction using pedicled flaps is an effective, economic and reliable method for oncologic and functional purposes.