Assessment of Quality of Life in Head-and-Neck Oncologic Patients with Intraoral Soft-Tissue Defects Reconstructed with Buccinator Myomucosal Flap

Abstract

The aim of this study is to evaluate the functional outcomes and quality of life (QoL) in oncologic patients with intraoral defects reconstructed with the buccinator myomucosal flap. A retrospective study was performed involving 39 patients with intraoral soft-tissue defects, reconstructed with a buccinator myomucosal flap during a six-year period. Patients completed the European Organization for Research and Treatment of Cancer questionnaires, the standard questionnaire (QLQ-C30) and the head-and-neck specific module (QLQ-H&N35). Thirty-nine patients with a mean age of 61.23 ± 15.80 years were included in the study. Thirty-three patients were diagnosed with an oncological condition (84.61%). Six patients (15.38%) developed orosinusal communication and underwent extensive debridement. The median global-health-status score was 79.27 and emotional performance was the lowest scoring, with a mean score of 76.93. As for the symptom items, the most outstanding were dental problems (33.33), oral opening (31.62) and dry mouth (37.61), followed by sticky saliva (24.79), problems with social eating (21.15) and pain (19.87). The most significant symptoms were radiotherapy-related adverse effects such as pain, fatigue, dental problems and dry mouth. Patients reconstructed with the buccinator myomucosal flap develop a good quality of life for all types of activities, and a correct function and aesthetics. Postoperative radiotherapy is associated with a poorer quality of life, and can lead to impairment of several symptoms such as swallowing, oral opening and dry mouth.

Assessment of quality of life in head and neck cancer survivors

“…-Radioterapia. Aunque existen trabajos que no hallan peores resultados de CV por radioterapia en cáncer de laringe y orofaringe (45), la mayoría reporta un efecto negativo (25,30).…”

Intraoral flaps for oral cavity and oropharyngeal reconstruction

“…Colella et al [11 ▪▪ ] emphasized its suitability for comorbid patients with poor systemic conditions. Recent studies assessing the quality of life and functional outcomes in head and neck oncologic patients following BMM flaps to reconstruct intraoral soft-tissue defects, found that prior radiation and neck dissection are not a contraindication to its use [24 ▪ ,25 ▪ ].…”

“…Potential complications of Bozola's flap mirror other loco-regional flaps and include partial necrosis of the flap necessitating removal of the ischaemic portion, complete flap failure, orocutaneous fistula and parotid duct damage. A reduction in mouth opening due to contracture (may require Z-plasty) and limitation of tongue mobility requiring detachment of the flap pedicle as well as temporary deficit of orbicularis oris have been reported [11 ▪▪ ,24 ▪ ,25 ▪ ]. Advantages of this flap are numerous, including short operative times (< 1 h), no requirement for microsurgery, a reduced complication rate with good quality of life and aesthetic outcome (owing to the use of intra oral incision and minimal donor site morbidity) [11 ▪▪ ,23,24 ▪ ,25 ▪ ].…”

“…A reduction in mouth opening due to contracture (may require Z-plasty) and limitation of tongue mobility requiring detachment of the flap pedicle as well as temporary deficit of orbicularis oris have been reported [11 ▪▪ ,24 ▪ ,25 ▪ ]. Advantages of this flap are numerous, including short operative times (< 1 h), no requirement for microsurgery, a reduced complication rate with good quality of life and aesthetic outcome (owing to the use of intra oral incision and minimal donor site morbidity) [11 ▪▪ ,23,24 ▪ ,25 ▪ ]. Bozola's flap can be used with the placement of osseointegrated implants [25 ▪ ].…”

“…Advantages of this flap are numerous, including short operative times (< 1 h), no requirement for microsurgery, a reduced complication rate with good quality of life and aesthetic outcome (owing to the use of intra oral incision and minimal donor site morbidity) [11 ▪▪ ,23,24 ▪ ,25 ▪ ]. Bozola's flap can be used with the placement of osseointegrated implants [25 ▪ ]. Despite its seemingly smaller size, considerable buccal mucosa can be incorporated without significant donor site morbidity, and it is an excellent option for centres where microsurgery is unavailable [11 ▪▪ ].…”