Functinal and aesthetic outcome of reconstruction of large oro-facial defects involving the lip after tumor resection

Abstract

Background: Squamous cell carcinoma of the head and neck is a challenging disease to both surgeons and radiation oncologists due to proximity of many important anatomical structures. Surgery could be curative as these cancers usually metastasize very late by blood stream.

Aim of the work: This work addresses the oncologic, functional and aesthetic factors affecting reconstruction of large orofacial defects involving the lip following tumor resection.

Patients and methods: The study reviews the surgical outcome of one hundred and twelve patients with invasive tumors at, or extending to, the lip(s), treated at the Mansoura University-Surgical Oncology Department, from January 2000 to January 2005. Tumor stage were T2 (43), T3 (56) and T4 (13). Nodal state was N0 in 80, N1 in 29 and N2 in three cases. AJCC stage grouping was II (T2N0) in 33 patients, stage III (T3N0 or T1-3N1) in 64 cases and stage IV (T4 due to bone erosion or N2) in 15 cases. The technique used for lip reconstruction was: Unilateral or bilateral myocutaneous depressor anguli oris flap (MCDAOF) for isolated lip defect (n=63). Bilateral myocutaneous depressor anguli oris (MCDAOF) plus local cervical rotational flap chin defects (n=3). Pectoralis major myocutaneous pedicled flap for cheek defects involving the lip together with a tongue flap for mucosal reconstruction (n=35). Sternocleidomastoid clavicular myo-osseous flap for concomitant mandibular defects (n=12).

Results: Aesthetic and functional results are evaluated regarding appearance, oral incompetence, disabling microstomia and eating difficulties. Depressor anguli oris reconstruction allowed functioning static and dynamic oral function in all cases in contrast to the Pectorails major flap. There were 18 cases of oral incompetence (46.1%), nine cases of speech difficulty (23%) and five patients with poor cosmetic appearance within the second group. Total flap loss was not encountered, Partial flap loss affected thirteen depressor anguli oris flaps (21.3%) and six pectoral flaps (15.3%).