The twilight of the 20th century was a time of many advances in the management of head and neck cancer, but perhaps none have been so dramatic as those found in the reconstruction of defects of the oral cavity. The incidence of oral cavity carcinoma remains tied to the usage of tobacco and alcohol products, and thus, although preventable, is still quite prevalent. While radiotherapy has made advances as well, surgery remains the mainstay of management of oral cavity carcinoma. Unfortunately, surgical extirpation of oral cancers may result in significant functional and aesthetic compromise unless appropriate reconstructive and rehabilitative approaches are utilized. This text provides a comprehensive and detailed summary of these methods.
Unfortunately, the oral cavity is a major component of personal, professional, and social interaction through speech, deglutition, respiration, and cosmesis. It also serves in many aspects as a dividing line between dental and medical specialists related to appropriate oral and dental health. These specialists from a variety of backgrounds must collaborate in providing the optimal care for oral cancer patients. Additionally, the impact of surgical treatment of oral cavity carcinoma can be very profound for an individual. The success of reconstructive efforts in the oral cavity may be the difference between the retention of an individual as a productive member of society or complete social isolation.
Reconstructive management of oral cavity defects has now progressed beyond primary closure and skin grafts to a variety of pedicled flaps and, more recently, to microvascular free tissue transfers of composite flaps that can be tailor designed to match the missing tissues. These advances arm the reconstructive surgeon with a wide variety of options to consider when faced with an oral cavity defect. Additionally, the oncologic surgeon may now consider the resection of large debilitating tumors, which would have previously been deemed unresectable without the current options for complex reconstruction.
With the wide variety of reconstructive techniques for the oral cavity now available, the surgeon is faced with making choices for the repair of individual defects. Each patient and defect of the oral cavity is unique and requires a multidis-ciplinary approach to optimal function and cosmesis. The successful reconstructive surgeon relies heavily on experience in making these difficult decisions, taking a multitude of factors unique to a given situation into consideration.
Thus, the genesis of this text was to draw upon some of the most active and experienced oral and head and neck reconstructive surgeons to outline their approach to managing very site-specific defects of the oral cavity. A review of (i) oral cavity anatomy and physiology, (ii) benign and malignant pathology, (iii) reconstructive history with patient evaluation and, (iv) surgical approaches are presented to help organize the surgeons approach to these challenging patients. Each major subsite of the oral cavity (lip, cheek, tongue, palate, floor of mouth, mandible, etc.) is addressed through an individual and comprehensive chapter to provide the specific anatomical, physiological, and functional issues followed by a discussion of reconstructive options from simple to complex with the advantages and disadvantages of each reviewed. An effort is made to provide insight into the key factors that influence decision making by the surgeon as well as technical "tricks of the trade'' to allow for maximal success and the avoidance of pitfalls.
We intend that this text will serve as a compilation of the current collective knowledge of how to manage defects of the oral cavity to provide the most functional and aesthetic results possible. We hope this will prove useful to the reconstructive neophyte and the experienced surgeon, as they face these most challenging of defects, to help provide individual patients with the best possible outcome.
Special thanks to LifeCell Corporation and Synthes Maxillofacial for the support to develop and publish this text.
Terry A. Day Douglas A. Girod
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