Functional Outcomes with Facial Artery Musculo-Mucosal (FAMM) Flap and Dental Implants for Reconstruction of Floor of the Mouth and Tongue Defects in Oncologic Patients

Abstract

Optimal functional outcomes in oncologic patients with squamous cell carcinoma (SCCA) of the tongue and floor of the mouth require good lingual mobility, adequate facial competence, the cheek suction effect and dental rehabilitation with osseointegrated implants. In this study, twenty-two oncologic patients who had been diagnosed with intraoral SCCA affecting the tongue and the floor of the mouth and who had undergone wide resection of the tumor and immediate reconstruction with an inferiorly pedicled FAMM flap and immediate osseointegrated implants were assessed. Lingual mobility, speech articulation, deglutition, implant success rate, mouth opening, and aesthetic results were evaluated. All patients were staged as T2 and the defect size ranged from 3.7 × 2.1 cm to 6.3 × 4.2 cm. A selective neck dissection was performed in all patients as part of their oncologic treatment, either electively or for node positive disease. Thirteen patients (59%) were diagnosed with node positive disease and underwent adjuvant radiotherapy. A total of 101 osseointegrated implants were placed for prosthetic rehabilitation and 8 implants were lost (7.9%), of which 7 received radiotherapy (87.5%). The implant success rate was 92.1%. Mouth opening was reported as normal in 19 patients (86.3%). Tongue tip elevation was reported as excellent in 19 patients (86.3%) and good in 3 patients (13.6%). Lingual protrusion was referred to as excellent in 15 patients (68.2%) and good in 6 patients (27.2%). Lateral excursion was reported as excellent in 14 patients (63.6%) and good in 7 patients (31.8%). In terms of speech articulation, 20 patients reported normal speech (90.9%). Regarding deglutition, 19 patients (86.3%) reported a regular diet while a soft diet was reported by 3 patients (13.7%). Aesthetic results were referred to as excellent in 17 patients (77.3%). FAMM flaps, immediate implants and fixed prostheses enable the functional rehabilitation of oncologic patients, optimizing aesthetics and functional outcomes even in patients undergoing irradiation, thus returning oncologic patients to an excellent quality of life.

Reconstruction with facial artery musculo-mucosal flap (FAMM.F) after resection of upper lip pleomorphic adenoma: Case report

“…Speech and swallowing outcomes were similar in both techniques. The same results were obtained from Navarro Cuéllar et al [ 17 ] study. In this study, twenty-two patients with intraoral squamous cell carcinoma affecting the tongue and the floor of the mouth who had undergone simultaneous wide resection of the tumor and immediate reconstruction with an inferiorly pedicled FAMM flap were assessed.…”

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

“…Rahpeyma [1] described in 2013 a classification based on its pedicle: The buccinator flap is very versatile, safe and reliable. It provides a wide arc of rotation for reconstruction of different locations such as the nasal cavity, palate, maxilla, tongue, floor of the mouth, mandible, oropharynx and lips [2,10]. In addition, it provides optimal thickness with a mucosa of similar color and texture to the rest of the intraoral soft tissues and the ability to secrete saliva, which allows for an excellent functional result [13,14].…”

“…Restoration of functionality, esthetics and quality of life after oncologic surgery or intraoral sequelae are some of the main challenges of head and neck surgery. Optimal functionality requires good lingual mobility and adequate lip competence, to allow adequate swallowing, breathing, and speech, to perform basic daily needs [2].…”

“…Extensive or complex defects are usually reconstructed with free flaps, depending on patient morbidity and technical limitations. Medium-sized defects are usually reconstructed with local flaps that provide similar tissue, with low morbidity [1][2][3][4].…”