Surgical oncology and reconstruction
Clinical and Histological Basis for the Use of Nasolabial Tissues in the Surgical Management of Oral Submucous Fibrosis

https://doi.org/10.1016/j.joms.2015.07.017Get rights and content

Purpose

The authors planned a clinical and histopathologic study to examine the behavior of nasolabial tissues (full-thickness skin flap) after being inset into the oral cavity for oral submucous fibrosis (OSMF) under the premise that skin that is foreign tissue to the oral cavity would be devoid of pathologic changes.

Materials and Methods

Fourteen patients with OSMF and mouth openings with an interincisal distance shorter than 28 mm were included. The flap was evaluated clinically for 10 years, during which biopsy specimen was obtained from the mucocutaneous junction of the inset flap for histopathologic examination.

Results

In this series, complications such as flap loss, infection, flap necrosis, obstructive sialadenitis, and damage to facial nerve branches were not observed. However, intraoral hair growth and extraoral scar at the donor site were seen in all patients, 3 of whom subsequently underwent scar revision. Histopathologically, the inset flap showed decreased keratinization and loss of adnexal structures. A mean mouth opening of 43.2 mm was achieved at 10 years postoperatively (mean increase, 24.4 mm). No relapse was encountered, even at the last follow-up.

Conclusion

The nasolabial island flap or any other full-thickness skin flap could be a viable and reliable option for reconstruction of intraoral defects from OSMF.

Section snippets

Materials and Methods

Patients 17 to 45 years old with a complaint of restricted mouth opening or burning sensation of the buccal mucosa or their combination were included in the study. All patients provided a history of tobacco use or chewing betel nut (Table 1). None of these patients were smokers. Their OSMF was confirmed based on thorough clinical and histopathologic examinations. Routine hematologic investigations and radiography were performed for all patients. This study was approved by the local

Results

In the present series, complications such as flap loss, infection, flap necrosis, obstructive sialadenitis, and damage to facial nerve branches were not observed. However, intraoral hair growth and extraoral scar at the donor site were seen in all patients, 3 of whom subsequently underwent scar revision (Table 2). Histopathologically, the skin flap showed fewer adnexal structures, normal vascularity, and fibrocellular stroma (Fig 12). The buccal mucosa showed atrophic epithelium, muscle

Discussion

Various surgical modalities have been described in the literature. Results with skin grafting to cover raw areas have been disappointing because the incidence of shrinkage, contracture, and rejection of graft was found to be very high owing to poor oral conditions and subsequent recurrence of symptoms.15 Split-thickness skin grafts and bilateral temporalis muscle myotomy or coronoidectomy can be effective, but have the drawbacks of secondary contracture formation in the temporalis tendon and

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