Mylohyoid advancement flap for closure of composite oral cavity defects

To describe a new surgical procedure in the reconstruction of composite oral cavity resections.

Retrospective chart review for all patients who received mylohyoid pull through muscle flap for reconstruction of oral composite resection with marginal mandibulectomy by the senior author between 1999 and 2008.

Data gathered from the chart review included demographics, pathologic diagnosis, tumor margins, use of reconstruction plate, exposure to radiotherapy, need for gastrostomy tube, flap viability, and flap complications.

Twenty-nine patients received composite resection, marginal mandibulectomy, and reconstruction with the mylohyoid muscle flap between 1999 and 2008. Twenty-four of the 29 patients (82.7%) had a partial glossectomy as part of the resection. Flap success was 100%. Complications included partial skin graft loss (2 of 29) and partial flap dehiscence (2 of 29). Total complication rate was 13.8%. Twenty-five patients (86%) were exposed to external-beam radiotherapy. Two patients required supplemental alimentation with a gastrostomy tube. There were no cases of osteoradionecrosis.

The mylohyoid flap is a valuable addition to the armamentarium of anterior oral cavity closures. The procedure is intuitive, and surgical time is miniscule. This procedure can often be used in cases previously requiring free flap closure. It allows a quick return to oral alimentation and has minimal donor site morbidity.