Staged mandibular lip flap for closure of a large palatal defect after maxillectomy in a dog

Abstract

Objective: To report closure of an oronasal defect secondary to maxillectomy with a staged mandibular lip flap. Study design: Case report Animals: One 9-year-old female spayed golden retriever. Methods: A combined dorsolateral and intraoral approach was used to perform a central maxillectomy to excise a 2.4-× 2-× 2.7-cm oral osteosarcoma with 1-cm margins. A buccal mucosal flap was used to close the palatal defect but the site subsequently dehisced. A staged mandibular lip flap was performed to close the defect. An incision was made on the mandible at the intersection of the buccal mucosa and gingiva from the mandibular canine to the level of the commissure. A second incision was made 3 cm ventral to the lip margin. The flap pedicle was based at the commissure. The flap was rotated to cover the palatal defect from rostral to the canine tooth to the fourth premolar. A second procedure was performed 4 weeks after flap placement to desquamate the haired skin and transect the flap pedicle. Results: Partial dehiscence at the caudal aspect of the flap occurred after the first revision. The defect was closed after pedicle transection on day 41, with acceptable cosmesis. The dog was eating canned food with no evidence of discomfort 159 days after the maxillectomy. Recurrence was noted on day 270 postoperatively. Conclusion: Closure of a large palatal defect with a staged mandibular lip flap led to good cosmesis and function.

Sternohyoideus‐sternothyroideus muscle flap to reconstruct oronasal fistulas due to maxillary cancer in four dogs

“… 9 The staged mandibular lip flap required two procedures. 10 Furthermore, the mandibular lip might not maintain its normal blood supply in some dogs with maxillary tumors. A free auricular cartilage autograft was used for repair of a small (5 mm x 3 mm) mid‐palatal defect.…”

“…Microvascular transfer requires special training and equipment 9 . The staged mandibular lip flap required two procedures 10 . Furthermore, the mandibular lip might not maintain its normal blood supply in some dogs with maxillary tumors.…”

Buccal transposition flap for closure of maxillary lip defects in 5 dogs

“…Tension-free closure of defects following tumor resection can be challenging when reconciling the limited availability of local tissues, the effects of differing tissues on patient function, and the impact of cosmesis on owner perception. Various techniques have been used to address maxillary lip defects, [1][2][3][4][5][6][7][8][9] with the most common techniques being labial advancement flaps and angularis oris axial pattern flaps. 6,7 With an advancement flap, tension and elastic recoil limit the size of the defect amenable to closure.…”

“…6,7 With an advancement flap, tension and elastic recoil limit the size of the defect amenable to closure. 1 Many of these flaps do not include mucosa at the reconstructed oral surface, [6][7][8][9] which may lead to dermatitis involving intraoral skin, or may require further surgery.…”