Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.
Department of Otorhinolaryngology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.
Medicine (Baltimore). 2023 May 26;102(21):e33786. doi: 10.1097/MD.0000000000033786.
Although regional metastasis to the lymph nodes is common in advanced oral cancer, extensive local invasion into surrounding structures such as the mandible, skin and soft tissue of the neck, and masticator space is relatively rare. Sometimes surgical treatment cannot be performed and only palliative chemotherapy and radiation therapy are offered to preserve the quality of life of patients with advanced oral cancer. Nevertheless, the surgical resection of tumors remains the most effective treatment. This study presents a case of aggressive mouth floor cancer in which extensive composite defects on the mouth floor, oral mucosa, mandible, skin and soft tissue of the neck caused by tumor resection were reconstructed.
A 66-year-old man and a 65-year-old man with no significant personal or family history visited our clinic due to a large and multiple masses on the floor of the mouth and both sides of the neck.
Histopathological evaluation of the biopsy specimen revealed squamous cell carcinoma.
A fibula osteocutaneous free flap and customized titanium plate were used for the intraoral lining. Mandibular reconstruction was performed using a 3D-printed bone model, and an anterolateral thigh free flap was used to resurface the anterior of the neck.
Reconstruction using this method was successful, and excellent functional and aesthetic outcomes were achieved without cancer recurrence.
This study show that the reconstruction of extensive composite defects of the oral mucosa, mandible, and neck soft tissue following surgical resection of mouth floor cancer can be performed in a single-stage operation. Through a single-stage reconstruction, both excellent functional aspects without cancer recurrence and satisfactory aesthetic outcomes can be obtained.
尽管局部淋巴结转移在晚期口腔癌中很常见，但广泛的局部侵犯周围结构，如下颌骨、颈部皮肤和软组织以及咀嚼肌间隙则相对少见。有时手术治疗无法进行，只能提供姑息性化疗和放疗，以维持晚期口腔癌患者的生活质量。然而，手术切除仍然是最有效的治疗方法。本研究介绍了一例侵袭性口底癌患者，该患者因肿瘤切除导致口底、口腔黏膜、下颌骨、颈部皮肤和软组织广泛复合性缺损，并进行了重建。
一名 66 岁男性和一名 65 岁男性，均无明显个人或家族病史，因口底和颈部两侧出现多个大肿块就诊于我院。
活检标本的组织病理学评估显示为鳞状细胞癌。
使用腓骨骨皮瓣和定制钛板进行口内衬里。使用 3D 打印骨模型进行下颌骨重建，使用股前外侧游离皮瓣修复颈部前侧。
采用该方法进行重建获得成功，无癌症复发，且功能和美观效果均极佳。
本研究表明，在口底癌手术后，可以进行单一阶段手术来重建口腔黏膜、下颌骨和颈部软组织的广泛复合性缺损。通过单阶段重建，可以获得无癌症复发的出色功能和令人满意的美观效果。
