Multi-dimensional analysis of oral cavity and oropharyngeal defects following cancer extirpation surgery, a cadaveric study

Abstract

BackgroundDefects following resection of tumors in the head and neck region are complex; more detailed and defect-specific reconstruction would likely result in better functional and cosmetic outcomes. The objectives of our study were: 1) to improve the understanding of the two- and three-dimensional nature of oral cavity and oropharyngeal defects following oncological resection and 2) to assess the geometric dimensions and the shapes of fasciocutaneous free flaps and locoregional tissue flaps required for reconstruction of these defects.MethodsThis study was an anatomic cadaveric study which involved creating defects in the oral cavity and oropharynx in two cadaveric specimens. Specifically, partial and total glossectomies, floor of mouth excisions, and base of tongue excisions were carried out. These subsites were subsequently geometrically analyzed and their volumes measured. The two-dimensional (2D) assessment of these three-dimensional (3D) structures included measures of surface area and assessment of tissue contours and shapes.ResultsThe resected specimens all demonstrated unique dimensional geometry for the various anatomic sites. Using 2D analysis, hemiglossectomy defects revealed right triangle geometry, whereas total glossectomy geometry was a square. Finally, the base of tongue defects exhibited a trapezoid shape.ConclusionsCustomizing the geometry and dimensions of fasciocutaneous free flaps so that they are specific to the confronted head and neck defects will likely result in better functional and cosmetic outcomes.

Tongue reconstruction: Rebuilding mobile three‐dimensional structures from immobile two‐dimensional substrates, a fresh cadaver study

“…An "ABC" flap with three sectors was described by Wang et al, and this shape most closely mimics the bullet shape described in the current study. 17 A recent group in China described a "five-point eight-line segment" to reconstruct the oral hemi-tongue. 17 A recent group in China described a "five-point eight-line segment" to reconstruct the oral hemi-tongue.…”

“…4 The typical flap size for oral hemi-tongue defects has been described to be~9 × 6 cm. 17 Tarsitano et al have demonstrated that hemi-tongue reconstruction needs at least a 20% volume increase to maintain form over time. The stretched length appears consistent with what previous reconstructive surgeons found in vivo.…”

“…A similar study was conducted on preserved cadavers, which showed similar results. 17 However, the previous study only included two cadavers and is limited by the quality of the tissue as it was embalmed and not in a state similar to what a surgeon would find in the operating room. Differences in shapes and dimensions between the two studies are likely due to this fact.…”

“…29 Idris et al found a similar shape to be the unfolded shape of an oral hemi-tongue in preserved cadavers. 17 A recent group in China described a "five-point eight-line segment" to reconstruct the oral hemi-tongue. This design essentially uses a very similar shape to the bullet and achieves increased bulk by folding the flap over itself.…”

“…13 Idris et al found similar patterns in preserved cadavers. 17 Tarsitano et al have demonstrated that hemi-tongue reconstruction needs at least a 20% volume increase to maintain form over time. 13 It is conceivable that a bullet shape with a length of 9 cm and a width of 6 cm will likely fit most oral hemi-tongue defects.…”