Abstract
We performed fifty-six immediate reconstructions following the radical resection of cancers of the oral cavity in 54 patients using 64 various cutaneous and musclocutaneous flaps during 1977 to 1990. W e conducted a retrospective analysis of the cases and the clinical studies.
Thirty-two patients were primary cases (Stage II : 5, Stage III : 8, Stage IV : 19) and 22 were secondary (recurrent) cases. The primary sites of the cancer were the tongue in 20 cases, the lower gingiva in 12 cases, the floor of the mouth in 10 cases, the buccal mucosa and oropharynx in five cases, and one case each in the upper gingiva and submandibular gland. A pathological diagnosis revealed that fifty-one cases had squamous cell carcinoma, two cases had salivary gland carcinoma, and one case had undifferenciated carcinoma. The size of the excisions were varied according to the primary site and tumor stages. All reconstructive cutaneous or musclocutaneous flaps were composed of pectoraris major musclocutaneous flap in 31 cases, deltopectoralis flap in 18 cases, lattissimus dorsi musclocutaneous flap in seven cases, free radial forearm flap in five cases, and sternocleidomastoid musclocutaneous flap in two cases. The mean operation time was eight hours and 50 minutes, total blood loss was 1, 493 grams. The complete survival rate of reconstructed flaps was obtained in 71.4% of these cases. W e followed up these cases two to 15 years after the operation. The five year cumulative survival rate of all primary cases was 51.7%, that of all secondary cases was 24.1% that of total cases 42.5% according to Kaplan-Meier's method.
From the above results, we concluded that combined resection and reconstructive surgery is an effective form of therapy for advanced oral cancers. The problems yet to be solved are how to reduce the number of recurrent cases, the developement of effective chemotherapy for metastases, the detection of double cancer in the early stages, the development of a functional reconstruction following the resection of oropharyx, and the development of biomaterials.
