Oral reconstruction

Abstract

A successful outcome in oral cancer surgery is firstly determined by adequate oncologic resection with clear margins and secondly reconstruction of the resultant defect that restores both form and function. This chapter focuses on the latter objective. Subsites of the oral cavity (lip, cheek, tongue, floor of mouth, mandible, and maxilla) are discussed according to function, morbidity, and reconstructive options, which are organized from simplest to most complex. Arguably the greatest challenge of oral cancer surgery is reconstruction that restores the patient's premorbid quality of life. True oral cavity malignancies, as distinguished from those arising in the oropharynx, are typically amenable to resection with acceptable oncologic outcome. However, the functional aspects of the oral cavity are among the most important in the body and are extremely sensitive to alteration resulting from even an apparently small resection. The mouth is of critical importance for both nutrition (mastication and deglutition) and social interaction (speech, facial expression), two of the most basic functions on which quality of life depends. All these functions depend on the anatomic integrity and coordinated action of organs within a very small tissue volume. Oral squamous cell carcinoma, the typical malignant pathology requiring resection from the oral cavity, is ideally resected with a 1 cm margin in all directions, more than doubling the volume resected for lesions up to 2.5 cm in diameter. Many patients present with oral malignancies of a size requiring significant resection even before these margins are applied.