In 17 cases of tumors of the oral cavity, maxillofacial defects were reconstructed immediately after radical surgery using pectoralis major and/or latissimus dorsi myocutaneous flap.
The diagnosis for 16 cases were carcinomas of the oral cavity and in these cases (except one with adenocarcinoma) patients had received irradiation therapy prior to the surgery. The only case of benign tumor was buccal region hemangioma.In all of the cases, satisfactory results were obtained though partial necrosis of flap was observed in 3 cases.
Previously A-O reconstruction plate was used for a primary repair of mandibular bone defect in our hospital.Recently the authors have experienced the use of a sternum pectoralis major and a rib latissimus dorsi osteocompound flap.However, the curve of rib was opposed to a normal mandibular arch and perforation of pleura may occur during harvesting a sternum or a rib.
Myocutaneous flap for repair of wide defect that necessitates mass augmentation seems to be efficient and reliable due to permanent blood supply.On the other hand, one disadvantage is the bulky deformity of the flap which makes functional restoration of the oral cavity more difficult.
In our view, some problems which should be considered for reconstructive surgery of head and neck tumor are the following.
1) Indication and selection of a flap
2) Method for mandibular bone reconstruction
3) Muscular volume of a flap and functional restoration
