Reconstructive options and issues after extensive infratemporal fossa clearance for bucco-alveolar cancer

This review addresses the timely and relevant challenge of reconstructing extensive infratemporal fossa defects following composite bucco-alveolar cancer resection. The complexity of these three-dimensional defects, involving mucosa, soft tissue, and skin, alongside the frequent need for adjuvant radiation and the proximity to dissected cervical vessels, necessitates a deliberate and robust reconstructive strategy.

Recent literature underscores a shift towards a structured, component-based reconstructive approach. This review details the utility and specific limitations of regional pedicled and microvascular free flap options to restore critical elements: bulk, reliable lining, and durable external cover. Key technical considerations prominently discussed include managing vessel-depleted necks, utilizing vein grafts, mitigating risks associated with postchemotherapy thrombosis, and planning for salvage surgery.

The reviewed evidence supports a tailored, flap-specific approach based on defect components and patient-specific risk factors. For optimal outcomes in this complex anatomical region, surgical planning must prioritize the introduction of well vascularized tissue to ensure healing, protect vital structures, and withstand adjuvant therapies, thereby reducing complications and facilitating rehabilitation.