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DOI: 10.1055/a-2263-8046
Salvage Reconstruction of Composite Defects of the Anterior Mandible, Floor of Mouth, and Lip
Funding This research was funded in part through National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748.
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 suspensionAuthors' 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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