Reconstruction Of Upper And Lower Lips And Mandible With Multiple Flaps Following Resection Of Extensive Squamous Cell Carcinoma

摘要

The reconstruction of composite defects of the mandible and both lips following oncological resection is challenging from both functional and aesthetic perspectives. This is a case report of simultaneous and immediate reconstruction of combined upper and lower lips and mandible with multiple flaps following resection of extensive squamous cell carcinoma. The patient was reconstructed with free fibula osteocutaneous flap, pedicled scalp flap, tongue flap, palmaris longus tendon sling and pectoralis major myocutaneous flap. At 4 weeks, patient demonstrated good speech and swallowing with an acceptable aesthetic result. Introduction The reconstruction of composite defects of the mandible and both lips following oncological resection is challenging (1). Structural restoration of skeletal support, internal lining and external skin cover must take into account the functional goals of oral competence, the ability to eat and drink, and intelligible speech. Functional restoration may involve neurorrhaphy to restore sensory or motor function, the use of static slings to support soft tissue reconstruction, or the transfer of skeletal muscle to restore oral sphincteric function. Aesthetic considerations also dictate that the reconstruction should attempt to minimize or at least camouflage the extent of disfigurement resulting from such extensive surgery (2). Case History A 56 year-old white male with a history of heavy alcohol and tobacco use presented with a 14-month history of an enlarging lesion involving the upper and lower lips. Video 1: Survey of lesionExamination revealed an ulcerating exophytic lesion involving the entire lower lip, right two-thirds of the upper lip, floor of mouth, right lower alveolus, buccal mucosa, and skin of the chin and right cheek. The tongue was mobile and unrestricted. There was numbness in the mental area, and palpable bilateral cervical lymphadenopathy at Levels and II. Video 2: FunctionThe patient wore ill-fitting dentures and was maintaining his weight through a soft diet. His speech was intelligible.