Aesthetic aspects of composite oromandibular cancer resection and reconstruction

Disfigurement after oromandibular cancer surgery is as much feared as the tumor itself. A deviated jaw, collapsed neck and muffled speech are external markers that may prevent normal life. Yet such stigmata are not necessary. For two years we have used an immediate reconstruction that avoids these problems. In 12 patients we used a pectoralis musculocutaneous flap plus a stainless steel shaped bridging bone plate placed under or through the flap. The flap reconstructs the floor of the mouth, while the bridging bone plate preserves mandibular continuity. A McFee incision avoids vertical scarring, and the muscle pedicle duplicates the missing neck contents. Meticulous lip closure completes the procedure, which often does not necessitate tracheotomy scarring. Our patients have maintained a highly satisfactory appearance of face and jaw, with normal swallowing and clear speech. In treatment of oromandibular cancer, aesthetic considerations are essential.