RECONSTRUCTION OF THE ORAL CAVITY AFTER EXTIRPATION OF THE MALIGNANT TUMOR OF THE ORAL FLOOR AND THE MANDIBLE

Several surgical techniques to reconstruct the oral cavity after extirpation of the malignant tumor of the mandible and the oral floor were evaluated as to their indication in individual cases. The reconstruction was performed with forehead flap, D-Pflap and D-P flap combined with cervical flap. The reconstruction with forehead flap was the best procedures especially in dderlyI male patients, in whom the reconstruction could be complyed by two stages wlthshortest hospital stay without fixation of the neck.But this was not suitable forthefemale or young patients due to the scar formation on the forehead. D-P flap could be used in the following three ways. 1.The defect of the oral floor and the cheek is covered by theflap directly.The pedicle of the flap comes out in the submental area leaving small fistula antero-medial to the pedicle with the submandibular skin incision closed primarily. The procedure is completed in two stages with satisfactory cosmetic results but this is safely used only in cases with apparently good blood flow of the flap. 2. Skin incision is made in the upper neck to make hinged cervical flap. After hemimandibulectomy with dissection of the oral floor and the infratemporal fossa, the cheek and the infratemporal fossa are covered by the turned-in hinged cervical flap. Secondary defect of the upper neck and the medial portion of the oral floor is covered by the D-P flap, leaving large fistula in the submandibular area to be closed secondarily. This procedure can be safely combined with radical neck dissection and is suited to the male patients. 3.Skin incision is made along the submandibular natural skin crease and the D-P flap is transfered to cover the defect of the cheek and the infratemporal fossa primarily, where scar contracture causes the most apparent facial distortion. Medial portion of the oraldefect is covered by direct approximation of the tongue and the cervical skin edge with additional skin graft, which leaves large submandibular fistulae. The tongue is released and the oral floor is reconstructed with pedicle of the flap secondarily. This is suited to the young female, especially in cases with large defect of the cheek but can not be combined safely with primary radical neck dissection. In either methods, to prevent shifting of the remaining mandible after hemimandibulectomy, wearing of some kinds of sprint or Kirchner wire fixation are necessary for some postoperative period.