Pouch-Type Flap Configuration for the Reconstruction of Extensive Retromolar Defects

Area of Science:

• Oncology
• Oral and Maxillofacial Surgery
• Plastic Surgery

Background:

• Retromolar trigone carcinoma is rare but often diagnosed late due to complex anatomy.
• Surgical resection leads to significant defects in the maxilla, mandible, and buccal mucosa.
• Limited strategies exist for defect-oriented flap configuration in free-flap reconstruction.

Purpose of the Study:

• To evaluate the clinical utility of a pouch-type flap configuration.
• To assess its effectiveness in 3D reconstruction of extensive retromolar defects.
• To analyze functional and aesthetic outcomes post-reconstruction.

Main Methods:

• Retrospective review of 11 patients undergoing pouch-type flap reconstruction for retromolar defects (Jan 2022 - Jan 2025).
• Outcomes assessed via maximal mouth opening measurements and CT scans for cheek depression.
• Complete flap survival was the primary endpoint.

Main Results:

• All 11 patients achieved complete flap survival.
• Maximal mouth opening ranged from 18-45 mm.
• Excellent/good cheek contour outcomes were observed in 8/9 evaluable patients; radiotherapy impacted mouth opening.

Conclusions:

• The pouch-type flap configuration is a valuable reconstructive option for extensive retromolar defects.
• It facilitates 3D reconstruction and can mitigate postoperative trismus and cheek depression.
• Further research may explore optimizing flap design and managing radiotherapy effects.