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CC BY 4.0 · Arch Plast Surg
DOI: 10.1055/a-2263-8046
Ideas and Innovations

Salvage Reconstruction of Composite Defects of the Anterior Mandible, Floor of Mouth, and Lip

Farrukh A. Khalid 
1   Jinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, Pakistan
,
Omar A. Ahmed 
2   Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
,
Almeotan P. Khurshid 
1   Jinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, Pakistan
,
Abdul M. Mujahid 
1   Jinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, Pakistan
,
Junaid Ahmad 
1   Jinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, Pakistan
,
Muhammad Saleem 
1   Jinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, Pakistan
,
Muhammad A. Yousaf 
1   Jinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, Pakistan
,
Moazzam N. Tarar 
1   Jinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, Pakistan
,
Farooq Shahzad 
3   Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
› Author Affiliations Funding This research was funded in part through National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748.
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Abstract

Anterior mandible defects result in loss of support for the tongue, floor of the mouth and lower lip, resulting in impairment of airway, feeding, and speech. We treated four patients with these “Andy Gump” deformities. Reconstruction was performed with two free flaps: a fibula osteocutaneous flap for the anterior mandible and floor of the mouth, and a soft tissue free flap for the lip, chin, and anterior neck. The lower lip was suspended cranially with fascia or tendon grafts ± mini-temporalis turndown flaps. All flaps survived completely. All patients were tube feed-dependent before surgery; they all resumed an oral diet. All tracheostomies were decannulated. Lip competence was restored as evidenced by cessation of drooling. Speech improved from unintelligible to intelligible with frequent repetitions. Objective assessment was performed with the functional intraoral Glasgow scale; the mean FIGS score improved from 3.25 (range 3–4) to 11 (range 9–13). We conclude that composite anterior mandible and tongue defects have large tissue requirements that require multiple free flaps. Reconstruction leads to significant improvement in function.

Keywords

Andy Gump - anterior mandible - free flap - functional intraoral Glasgow scale - lip suspension

Authors' Contributions

All authors have reviewed results and approve the final version of the paper. Individual author contributions are:

F.A.K.: study conception and design, data collection, data analysis, draft manuscript preparation.

O.A.A.: study conception and design, data analysis, draft manuscript preparation.

A.P.K.: data collection and analysis.

A.M.M.: data collection and analysis

J.A.: data collection and analysis

M.S.: data collection and analysis

M.A.Y.: data collection and analysis

M.N.T.: data collection and analysis

F.S.: study conception, draft manuscript preparation, data analysis.


Ethical Approval

This research was performed in accordance with the Ethical Principles for Medical Research Involving Human Subjects, as outlined in the Helsinki Declaration.


Patient Consent

Informed consent was obtained from all patients, including the use of their full-face pictures.




Publication History

Received: 28 June 2023

Accepted: 05 February 2024

Accepted Manuscript online:
07 February 2024

Article published online:
10 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Pogrel MA. Who was Andy Gump?. J Oral Maxillofac Surg 2010; 68 (03) 654-657
    Google Scholar
  • 2 Soutar D. Malignant Tumors of the Mouth, Jaws and Salivary Glands. London: Edward Arnold; 1995
    Google Scholar
  • 3 Goldie SJ, Jackson MS, Soutar DS, Shaw-Dunn J. The functional intraoral Glasgow scale (FIGS) in retromolar trigone cancer patients. J Plast Reconstr Aesthet Surg 2006; 59 (07) 743-746
    Google Scholar
  • 4 Ellabban MA, Shoaib T, Devine J. et al. The functional intraoral Glasgow scale in floor of mouth carcinoma: longitudinal assessment of 62 consecutive patients. Eur Arch Otorhinolaryngol 2013; 270 (03) 1055-1066
    Google Scholar
  • 5 Seshul MB, Sinn DP, Gerlock Jr AJ. The Andy Gump fracture of the mandible: a cause of respiratory obstruction or distress. J Trauma 1978; 18 (08) 611-612
    Google Scholar
  • 6 Shockley WW, Weissler MC, Pillsbury HC. Immediate mandibular replacement using reconstruction plates. Arch Otolaryngol Head Neck Surg 1991; 117 (07) 745-749 , discussion 750
    Google Scholar
  • 7 Jones NF, Vögelin E, Markowitz BL, Watson JP. Reconstruction of composite through-and-through mandibular defects with a double-skin paddle fibular osteocutaneous flap. Plast Reconstr Surg 2003; 112 (03) 758-765
    Google Scholar
  • 8 Chen HC, Demirkan F, Wei FC, Cheng SL, Cheng MH, Chen IH. Free fibula osteoseptocutaneous-pedicled pectoralis major myocutaneous flap combination in reconstruction of extensive composite mandibular defects. Plast Reconstr Surg 1999; 103 (03) 839-845
    Google Scholar
  • 9 Jeng SF, Kuo YR, Wei FC, Su CY, Chien CY. Reconstruction of extensive composite mandibular defects with large lip involvement by using double free flaps and fascia lata grafts for oral sphincters. Plast Reconstr Surg 2005; 115 (07) 1830-1836
    Google Scholar
  • 10 Gaggl A, Bürger H, Müller E, Chiari FM. A combined anterolateral thigh flap and vascularized iliac crest flap in the reconstruction of extended composite defects of the anterior mandible. Int J Oral Maxillofac Surg 2007; 36 (09) 849-853
    Google Scholar
  • 11 Mosahebi A, Chaudhry A, McCarthy CM. et al. Reconstruction of extensive composite posterolateral mandibular defects using nonosseous free tissue transfer. Plast Reconstr Surg 2009; 124 (05) 1571-1577
    Google Scholar
  • 12 Schusterman MA, Reece GP, Kroll SS, Weldon ME. Use of the AO plate for immediate mandibular reconstruction in cancer patients. Plast Reconstr Surg 1991; 88 (04) 588-593
    Google Scholar
  • 13 Boyd JB, Mulholland RS, Davidson J. et al. The free flap and plate in oromandibular reconstruction: long-term review and indications. Plast Reconstr Surg 1995; 95 (06) 1018-1028
    Google Scholar
  • 14 Wei FC, Celik N, Yang WG, Chen IH, Chang YM, Chen HC. Complications after reconstruction by plate and soft-tissue free flap in composite mandibular defects and secondary salvage reconstruction with osteocutaneous flap. Plast Reconstr Surg 2003; 112 (01) 37-42
    Google Scholar
  • 15 Zenn MR, Hidalgo DA, Cordeiro PG, Shah JP, Strong EW, Kraus DH. Current role of the radial forearm free flap in mandibular reconstruction. Plast Reconstr Surg 1997; 99 (04) 1012-1017
    Google Scholar
  • 16 Bianchi B, Ferri A, Ferrari S, Copelli C, Boni P, Sesenna E. Reconstruction of anterior through and through oromandibular defects following oncological resections. Microsurgery 2010; 30 (02) 97-104
    Google Scholar
  • 17 Weinzweig N, Weinzweig J. Current concepts in mandibular reconstruction by microsurgical free flaps. Surg Technol Int 1996; 5: 338-346
    Google Scholar
  • 18 Wells MD, Luce EA, Edwards AL, Vasconez HC, Sadove RC, Bouzaglou S. Sequentially linked free flaps in head and neck reconstruction. Clin Plast Surg 1994; 21 (01) 59-67
    Google Scholar
  • 19 Wei FC, Yazar S, Lin CH, Cheng MH, Tsao CK, Chiang YC. Double free flaps in head and neck reconstruction. Clin Plast Surg 2005; 32 (03) 303-308 , vv
    Google Scholar
  • 20 Urken ML, Weinberg H, Vickery C. et al. The combined sensate radical forearm and iliac crest free flaps for reconstruction of significant glossectomy-mandibulectomy defects. Laryngoscope 1992; 102 (05) 543-558
    Google Scholar