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The through-and-through oromandibular defect: rationale for aggressive reconstruction
J B Boyd1, S Morris, I B Rosen
1Toronto Hospital Head and Neck Unit, University of Toronto, Ontario, Canada.
Plastic and Reconstructive Surgery
|January 1, 1994
Summary
Microvascular reconstruction for advanced oral cancer significantly improves quality of life, enabling speech and oral diet despite grim prognoses. This palliative approach justifies surgery by reducing hospitalization and morbidity.
Area of Science:
- Head and Neck Surgery
- Oral Oncology
- Reconstructive Surgery
Background:
- Through-and-through oral cancer (T4+) presents a severe reconstructive challenge due to extensive tissue involvement (mucosa, mandible, skin).
- Patients with advanced oral cancer often have a poor prognosis, necessitating palliative reconstructive strategies.
Purpose of the Study:
- To evaluate the effectiveness of immediate microvascular reconstruction in patients with advanced oral cancer.
- To assess the functional outcomes and quality of life improvements following palliative reconstructive surgery.
Main Methods:
- Retrospective review of 38 patients undergoing immediate microvascular reconstruction after tumor ablation.
- Utilized iliac crest osteocutaneous flaps for large bony and soft-tissue defects; other flaps included pectoralis major, forehead, and latissimus dorsi.
Main Results:
- Microvascular reconstruction led to functional improvements, with 65% achieving intelligible speech and 84% tolerating a soft oral diet.
- Bony union occurred in 73% of patients, and 78% had their tracheostomies successfully closed.
- Despite the advanced stage, palliative surgery demonstrated benefits in quality of life, with a mean follow-up of 16 months.
Conclusions:
- Immediate, one-stage microvascular reconstruction is a valuable palliative approach for advanced oral cancer.
- This reconstructive method can significantly improve functional outcomes, reduce morbidity, and enhance the quality of life for patients facing devastating disease.