Microsurgical Reconstruction for Caustic Injuries of the Oral Cavity and Esophagus

Abstract

Ingestion of caustic material often produces profound and irreversible pathologic changes that require reconstructive surgery of the organs damaged. This report describes the authors' successful experience with microsurgical techniques that allowed adequate reconstruction in three patients with cicatricial contracture of the oral cavity and esophagus following ingestion of caustic substances. All patients had attempted suicide by ingesting liquid alkali. Patients #1 and #2 complained of limited mouth opening and impaired tongue movement due to oral scar contracture. Contracture release in the first patient resulted in a defect from the anterior border of the mandible to the retromolar region. The defect was resurfaced with a 6 x 12 cm free forearm flap. Release of the scar contracture in the second patient resulted in a long, narrow, tortuous defect that was difficult to cover, even with a forearm flap, and a jejunal segment was microsurgically transferred as a patch graft to reconstruct the defect. Patient #3 had dysphagia due to stricture of the cervical portion of the esophagus. The defect after resection of the cervical portion was reconstructed by free jejunal interposition. Appropriately selected free-flap transfer in each case provided a satisfactory restoration of function of the oropharyngeal and digestive passages.

Acquired synechia of the tongue to the mouth floor

“…The nature of the injury caused by caustic soda ingestion is determined by several factors, such as the type of substance, the quantity, the concentration, the morphologic form of the agent, and the length of time the agent is in contact with the tissue, as well as the intent 5 , 6 . Adults with suicidal intention often consume large amounts of corrosive agents, therefore, the degree of injury is higher than that seen with accidental ingestion 7 . Furthermore, the liquid form of the caustic agent makes it easy to be swallowed and to reach distant sites of the gastrointestinal tract.…”

Long Standing Intra Oral Acid Burn

“…The resultant defects have been covered by skin grafts or vascularized free soft tissue flaps like the radial forearm flap and free jejunum [4]. This is the first report that describes the use of local pedicled flap (buccal pad of fat) as well as coronoidectomy for the treatment of intra-oral burns.…”

“…Treatment of scar contractures due to exposure to corrosive substances that affect the whole oral cavity is challenging. Literature shows various articles on the management of esophageal and gastric damages due to caustic ingestion [2] but very few on the correction of scar contracture affecting the oral cavity [3][4][5]. This is probably because that the most common offending chemical agent is concentrated liquid alkali (lye, drain cleaners, and similar readily available household products).…”

“…Although the management of microstomia [1], esophageal strictures and other gastrointestinal complications secondary to acid ingestion have been well discussed in the literature [2], there are very few reports that deal with the correction of intra-oral scar contracture and tongue fusion [3][4][5]. There has been no report that describes the effects of long-standing oral contracture secondary to burns on the growth and development of the maxillofacial structures.…”

The sternocleidomastoid myocutaneous “patch esophagoplasty” for cervical esophageal stricture

“…These include local fasciocutaneous flaps, pedicled myocutaneous flaps, pedicled visceral flaps, free flaps, and free fasciocutaneous flaps. 1–16 The ideal reconstruction should be able to be completed in a single stage, have minimal morbidity, be reliable, well vascularized, technically simple, ultimately effective at restoring oral intake and nutrition, and cosmetically acceptable. 1, 17 It has been our experience that the sternocleidomastoid (SCM) myocutaneous flap satisfies all of the above objectives when used in the appropriately selected patient.…”