Article

A double-skin paddle radial forearm flap for the reconstruction of oral submucous fibrosis

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Abstract

Objective: Oral submucous fibrosis can result in progressive restriction of mouth opening. Surgical treatment is indicated for severe cases. An innovative technique, a double-skin paddle radial forearm flap, using only one forearm donor site to reconstruct the bilateral buccal defects, is described. Patients and Methods: A total of six patients, having severe oral submucous fibrosis, were treated between July 2002 and August 2004. The surgical procedure consists of (1) release of all the intraoral fibrotic tissue, (2) masticatory muscle myotomy and coronoidotomy, and (3) reconstruction with a double-skin paddle radial forearm flap. Results: The preoperative mouth opening was 2 to 5 mm (mean: 3.3 mm). The intraoperative mouth opening ranged from 13 to 20 mm (mean 16.5 mm) after submucous release and ranged from 32 to 42 mm (mean 35.5 mm) after further release via myotomy and coronoidotomy. The proximal flap incorporated one perforator in two patients and two perforators in the remaining 4 patients. The size of the flaps ranged from 8 to 9 cm in length and 2 to 2.5 cm in width. Five flaps survived uneventfully. Arterial thrombosis, developing 24 hours after the operation, was noted in one flap. The flap was successfully salvaged after emergent exploration. Temporomandibular joint subluxation developed in one patient and required surgical reduction. One patient needed flap revision due to bulkiness. The post-operative mouth-opening range was 22 to 37 mm (mean: 30 mm) at an average follow-up period of 19 months. The average increase of the mouth opening was 26.7 mm, compared with the preoperative interincisor distance. Conclusion: Double-skin paddle radial forearm flap allowed simultaneous reconstruction of two separate buccal defects using a single donor site and thus obviates the need for a second free flap.

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... The studies were published between 1987 and 2013, and we found considerable diversity both clinically and in the methods used among the studies. Samples sizes varied from 1 to 100 patients, and there were 651 in total (median (IQR) 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)). Seven studies were case reports, 22 28,30,32,36 and two 27,41 on noma (n=38). ...
... There was a male predominance in all studies of submucous fibrosis and cancer, and one study of noma had more women than men. 27 The mean age ranged from 16-71 (median (IQR) 43 (36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55) years), and duration of follow-up ranged from 6 months-2 years (median (IQR)12 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) months/study. In two studies duration of follow-up was not reported. ...
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... 64 The medical management is palliative therapy which is not going to reverse the condition completely. 65 Patient has to quit the habit, along with long duration of medication will benefit in mild to moderate way which is not up to the satisfaction of patient or original mouth opening 66,67 It will be useful in some extent only; if patient is in stage I transition where the burning sensation for hot spicy foods is started but no limited of mouth opening will be benefited. 68 The medical management has been summarized in the following table given by Auluck et al 69 ...
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... Hence, it is possible to design both an inferiorly based nasolabial flap, with the facial artery as its pedicle, and a superiorly based nasolabial flap with the infraorbital and transverse facial arteries as its pedicle. 5 Tongue flaps are bulky and when used bilaterally cause disarticulation, dysphagia, and increased chances of aspiration. In addition, the tongue is involved with the disease process in 38% cases. ...
... Medical treatment is indicated at an early stage but mostly patients present with moderate to severe form of diseaseb (Lee et al, 2006). Surgical treatment is indicated at this late and irreversible stage. ...
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