Intraoral microsurgical anastomosis of the free bony flaps – report on two cases

Introduction: In many cases of the oral tumors it is technically possible to perform intraoral resection. If reconstruction with free flap is necessary, we need to expose donor vessels usually on the neck or in naso-labial fold producing skin scars. We would like to present our experiences with intraoral technic for facial vessels exposer and microsurgical anastomosis.

Material and methods: 33 years old female with ameloblastoma of the alveolar process underwent partial maxillectomy and reconstruction with Iliac Crest Free Flap. Through buccal mucosa cut 3 cm distally to the labial angle we exposed facial vessels and microsurgical anastomosis was performed intraoraly. Bone segment was fixed with reconstructive titanium plate. Palate defect was covered with oblique abdominal muscles raised with iliac bone segment.

Second case was 16 years old patient with mandible angel ameloblastoma qualified for Fibula Free Flap reconstruction. After intraoral resection facial vessels were exposed and anastomosed as described above. Fibula flap was fixed to the remaining mandible segments with reconstructive titanium plate. Oral mucosa was primary closed over flap.

Results: In first case flap heal properly and we haven’t observed any complications. Patient was sent to prosthodontics for further dental rehabilitation.

In second case we lost flap due to infection.

Conclusions: Intraoral technic for tumor resection and reconstruction with microsurgical flaps is a promising method. It can be used in selected cases mostly for benign neoplasms. For better control of the vascularization part of the flap should be available for inspection.

Conflict of interest: None declared.

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Jan 27, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Intraoral microsurgical anastomosis of the free bony flaps – report on two cases
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