Roh Fukui

Reconstruction of the Floor of the Mouth Using Free Jejunal Grafts

Abstract Objective: To describe the postoperative function, benefits, and complications associated with free jejunal transfer for reconstruction of the floor of the mouth. Patients and Methods: Free jejunal grafts were used for reconstruction of the floor of the mouth in 6 patients after radical resection for cancer. Results: The mean score for the Japanese speech intelligibility test was 60.8% and all patients were able to swallow without difficulty. By fixing the mesenteric side of the jejunum to the mandible, it was possible to restore a lingual sulcus, which facilitated denture wearing. The severity of post-radiation xerostomia after surgery was evaluated by visual analogue scale. Xerostomia was significantly relieved for patients undergoing jejunal graft compared with other flaps. Conclusion: The benefits of this flap outweigh the disadvantages, and free jejunal transfer is well suited for reconstruction of the floor of the mouth.

Clinical Management and Outcome of Neck Recurrence after Neck Dissection for Oral Squamous Cell Carcinoma

Abstract Objective: To review the treatment for recurrence in the neck after neck dissection for oral squamous cell carcinoma and its outcome. Patients and Methods: Seven patients with neck recurrence after neck dissection for oral squamous cell carcinoma without recurrence of the primary tumour were treated between January 1990 and December 2000. Records were reviewed for site and stage of the primary tumour, initial treatment, and pathological findings, site and time of presentation of neck recurrence, and outcome and prognosis after treatment. Results: Tongue carcinoma was the primary site in 5 patients, floor of the mouth in 1 patient, and lower gingiva in 1 patient. Neck recurrence presented 7.5 months after the initial operation and was found at level 2 to level 5. Four patients underwent secondary surgery with or without adjuvant radiotherapy and chemotherapy. Two patients each had palliative radiotherapy and chemotherapy only. One patient was not fit for further treatment. Two patients remained alive at last follow-up of 30 months and 70 months, respectively. The other 5 patients lived for 2 to 16 months after the secondary treatment. The survival time for patients who accepted secondary surgery was 6 to 70 months in comparison to 2 to 4 months for patients who did not undergo secondary operation. Conclusions: This study demonstrates that neck recurrence often occurs in patients with tongue carcinoma and may be found at any lymph node level. Surgical resection of recurrent neck lesions, if feasible, is an effective method and should be considered.