Sameh Roshdy1, Mohamed T Hafez1, Islam A El Zahaby1, Osama Hussein1, Fayez Shahatto1, Mosab Shetiwy1, Shadi Awny1, Sherif Kotb1, Hend A El-Hadaad1 and Adel Denewer2*
1Department of Surgical Oncology, Oncology center, Faculty of Medicine, Mansoura University, Egypt 2Department of Clinical Oncology & Nuclear Medicine, Faculty of Medicine, Mansoura University, Egypt
Received: 09 September, 2015; Accepted: 07 December, 2015; Published: 10 November, 2015
Professor Adel Denewer, Head of Department of Surgery, Faculty of Medicine, Mansoura University, Egypt, Tel: +201223237791; E-mail:
Roshdy S, Hafez MT, El Zahaby IA, Hussein O, Shahatto F, et al. (2015) Retro-Molar Trigonal Reconstruction and Oncologic Outcomes after Resection of Large Malignant Ulcers in Elderly Patients. Arch Otolaryngol Rhinol 1(2): 053-057. DOI: 10.17352/2455-1759.000010
© 2015 Roshdy S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Buccal mucosa cancer; Oral cancers; Squamous cell cancer of oral mucosa; Submental
Objective:Buccal mucosa carcinoma represents 3 to 5% of oral-cavity cancer. Retromolar buccal trigon affected in one third of patients with buccal mucosal cancers. Squamous cell carcinoma is the commonest pathological finding.
Aim: The research was designed to study suitability of submental island flap and radial forearm free flap (RFFF) as one stage reconstructive procedure after resection of large retromolar-trigonal cancers. And to assess locoregional recurrence and disease free survival after adjuvant treatment.
Methods and techniques: Fifty three patients with retromolar-trigonal cancer underwent resection with safety margins, cervical block neck dissection and reconstruction with submental island flap and radial forearm free flap (RFFF) in oncology center Mansoura University from August 2010 to May 2014.
Results: Seven patients underwent RFFF, 46 patients reconstructed with sub-mental flap. Partial necrosis was encountered in 5 cases of sub-mental flaps but lost flaps were present in 2 cases of RFFF. 14 patients received neoadjuvant chemotherapy, 33 patients received postoperative radiotherapy. Local recurrence was 13.2%, 2 year disease free survival (DFS) was 72.7%.
Oral cavity cancer globally, wings between the sixth to the eighth most common malignancy; it comprises more than 30% of all head and neck cancers [1-3,4]. In Egypt about 4.500 people are diagnosed with oral cancer every year . Retromolar trigon (RMT) is the buccal region near the lower third molar tooth that has affected in 15% of all oral cancers [6-8]. Resection of RMT cancer with 1cm safety margins all round results in large oral defect. Small defects can be left to heal by secondary intention or are repaired by primary closure, buccal advancement flap, palatal pedicled flap, split-thickness skin grafting or tongue flap [9,10]. Reconstruction of larger retro-molar defects using pedicled buccal pad of fat flap is frequently insufficient and may be oncologically unsafe when the tumor is abutting or infiltrating the buccal pad of fat [11-15]. Pedicled and free myocutaneous flaps albeit safe and robust, are not suitable options due to additional, unnecessary muscle bulk. The pectoralis major myocutaneous flap carries about 15% flap related complications with the disadvantages of being bulky, the need of a second stage for pedicle division, unacceptable donor site scar in females [16,17]. Thus, RMT defects too wide to be covered with local flaps and are best served with regional or distant fasciocutaneous flap reconstruction. Defects of such size are typically covered with a free fasciocutaneous flap; the most commonly used of which are the radial forearm flaps (RFFF). The research was designed to test the safety and efficacy of submental island flap as one stage reconstructive procedure for large post-surgical RMT oral defects. We evaluated this technique in comparison with the RFFF as an accepted standard of care for similar cases.
Patients and Methods
This is a retrospective evaluation of prospectively collected patients’ data that was carried out from August 2010 to May 2014 for patients with buccal mucosal cancer originating in or extending to the RMT region and presenting to our clinic in Mansoura University Cancer Center in Egypt (Figure 1). We enrolled all cases with predicted post-resectional defects ≥4cm in greatest dimension. Pure soft tissue resection and marginal mandibular resections were included in the study. Patients with metastatic disease, poor performance, fully thickness bony defects necessitating mandibular reconstruction and patients who are salvaged by surgery after concurrent chemotherapy and/or radiotherapy were excluded from this study. All clinical procedures were conducted in accordance with the guidelines of the ethics committee of the Faculty of Medicine, Mansoura University, and after obtaining the written informed consent of the patients.