Marginal Mandibulectomy Defect Reconstruction with Pectoralis Major Myocutaneous (PMMC) Flap in Cases of Carcinoma Bucca
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ORIGINAL ARTICLE
Marginal Mandibulectomy Defect Reconstruction with Pectoralis Major Myocutaneous (PMMC) Flap in Cases of Carcinoma Buccal Mucosa: Experience from a Tertiary Cancer Institute Hemant Nemade 1 & Naren Bollineni 1 & Sagar Mortha 1 & G Jonathan 1 Subramanyeshwar Rao 1
&
Sravan Kumar 1
&
LMCS Rao 1
&
Received: 2 November 2019 / Accepted: 2 June 2020 # Indian Association of Surgical Oncology 2020
Abstract Patients with carcinoma buccal mucosa requiring marginal mandibulectomy pose various key challenges with regard to reconstruction. To study the role and feasibility of the PMMC flap reconstruction in patients of carcinoma buccal mucosa with intact mandible. Study design: retrospective analysis of prospectively maintained data at a tertiary cancer institute in India. Inclusion criteria: all patients of carcinoma buccal mucosa undergoing marginal mandibulectomy at our institute from 1st Jan 2015 to 31st March 2018 with reconstruction done by the PMMC flap. The retrospective analysis showed 82 patients satisfied the inclusion criteria. Median age of the patients was 46 years. Seventy-seven (93.90%) patients were male while 5 (6.09%) patients were female. Median Ryle’s tube dependency was 13 days. Median follow-up period was 28 months. All the patients had acceptable cosmesis and mouth opening with minimal morbidity. PMMC flap reconstruction after marginal mandibulectomy in patients with carcinoma buccal mucosa is a robust, cosmetically, and functionally acceptable option. Keywords Carcinoma buccal mucosa . PMMC flap . Mandibular invasion
Introduction
* G Jonathan [email protected] Hemant Nemade [email protected] Naren Bollineni [email protected] Sagar Mortha [email protected] Sravan Kumar [email protected] LMCS Rao [email protected] Subramanyeshwar Rao [email protected] 1
Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Banjara Hills Road No 10, Hyderabad, Telangana 500034, India
The mandible has paramount importance in maintaining the airway, the first phase of swallowing and articulation of speech [1]. Management of mandible in oral cancer has changed significantly with the increasing knowledge on patterns of mandibular invasion by the tumor [2–5]. In selected cases of oral cancer, wide local excision of the lesion with marginal mandibulectomy is preferred because maintaining the continuity of the mandible improves the quality of the life of the patient significantly. Its oncological safety is well established in the literature [6–10]. While microvascular reconstruction of the mandible with free bone flap is possible, marginal mandibulectomy continues to be relevant till date as a conservative procedure [11, 12]. Pectoralis major myocutaneous (PMMC) flap continues to be the workhorse flap for head and neck reconstruction as it is a reliable, simple, and cost-effective option [13]. PMMC is rarely utilized in marginal mandibulectomy defects due to concerns like pedicle compression, bulk of the flap, difficult inset,
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