Early Combination of an Obturator with a Free Flap to Prevent Palatal Dehiscence Following Oral Cancer Surgery: Technique and Indications
Tóm tắt
In the Indian subcontinent where tobacco chewing is rampant, composite 'bite' defects are common after oral cancer ablation, which comprise buccal mucosa, maxilla and mandible with or without skin. These are often reconstructed with soft tissue flaps like anterolateral thigh flaps, which provide ample soft tissue replacement. A common problem is palatal dehiscence where these flaps are inset, due to the dynamics of speaking and chewing, as well as the gravitational pull on the flap. We describe our technique of combining an early custom obturator for these patients in the post operative period, which helps support the palatal inset and prevent dehiscence. We describe in detail the indications and workflow for this technique, mechanism of action and outcomes. We show the successful result of use in a single patient with an early dehiscence and how it can be incorporated into standard workflow in selected patients at risk of dehiscence. This is a useful technique to prevent dehiscence in patients undergoing extensive buccal resections involving the maxilla. It allows for early oral intake and function while preventing dehiscence and dealyed wound healing, which is often costly.
Tài liệu tham khảo
Moreno MA, Skoracki RJ, Hanna EY et al (2010) Microvascular free flap reconstruction versus palatal obturation for maxillectomy defects. Head Neck 32:860–868
Bernhart BJ, Huryn JM, Disa J et al (2003) Hard palate resection, microvascular reconstruction, and prosthetic restoration: a 14-year retrospective analysis. Head Neck 25:671–680
Iyer S, Thankappan K (2014) Maxillary reconstruction: current concepts and controversies. Indian J Plast Surg 47(1):8–19
Pathak KA, Gupta S, Talole S, Khanna V, Chaturvedi P, Deshpande MS et al (2005) Advanced squamous cell carcinoma of lower gingivobuccal complex: patterns of spread and failure. Head Neck 27:597–605
Pillai V, Yadav V, Kekatpure V, Trivedi N, Chandrashekar NH, Shetty V, Rangappa V, Subramaniam N, Bhat V, Raghavan N, Kolur T, George N, Thomas T, Kuriakose MA (2019) Prognostic determinants of locally advanced buccal mucosa cancer: do we need to relook the current staging criteria? Oral Oncol 95:43–51
Kekatpure VD, Trivedi NP, Shetkar G, Manjula BV, Mathan Mohan A, Kuriakose MA (2011) Single perforator based anterolateral thigh flap for reconstruction of large composite defects of oral cavity. Oral Oncol 47(6):517–521
Agrawal K, Panda KN (2005) An innovative management of detached palatal mucoperiosteal flap from the hard palate (hanging palate). Plast Reconstr Surg 115(3):875–879. https://doi.org/10.1097/01.prs.0000153234.58643.44