Most oral cancer’s are” squamous cell carcinoma” which is very dangerous and it not only penetrates the bone and muscles but also affects the lungs and liver of the patient. In past, many different procedures were done in the removal of the neoplasm in the oral and jaw cavity. These procedures had side effects which were the deformity of the organs. But now the shape and function of the organs are given the same importance as well as removing the neoplasm. The new procedures, reconstruction of vessels tissues, and implants have reformed the reconstruction of oral problems. With these techniques, the quality of life of patients has become better than before. These methods obey the rule that if any organ from the body is taken out it should be “repaired or replaced”. (Chandu et al, p. 1).
Two main reconstructing procedures are flapping and grafting. Flaps are meant to be living tissues that are used as blood suppliers whereas grafts are not related to supplying blood. These procedures are further described individually (Chandu et al, p. 2).
Grafts
The normal procedure “split skin graft (SSG)” is mostly used in the reconstruction of small to medium sized problems. These grafts are filled in the hole and are punched in the cuts made in the skin for this specific reason. This punching is done to decrease the aggregate building of blood filled swelling. As the graft is cured it takes the color of the skin. (Chandu et al, p. 2).
Flaps
There are the following three different types of flaps:
Local flaps
Local flap is commonly known as “buccal pad of fat flap”. The most adaptable flap used for small to medium defects in mouth. This is a connecting flap between cheek and jaw artery tissues to the face arteries. The cheek consists of a cavity which is associated to the chewing organs. It takes about three to four weeks to cover the wound with normal cells during this time period the wound acts as a fat with inconstant amount of healing tissues. The flap will then successively protrude into the mouth but it will take about two months (Chandu et al, p. 3).
Regional flaps
This is a skin muscle flap used in the chest main muscle and its connecting skin. It is present in the chest from where the axillary’s artery arises. The regional flaps are mainly used in the defects of respiratory track and problems related to jaw. Regional flap is excavated in the neck to re build the thick layer of muscles on each side of the neck; it includes very thick tissues which makes it difficult to use so it is commonly used in those cases where the free flap process fails (Chandu et al, pp. 3-4).
Free flaps
As of the regional flaps, the free flaps have less thickness so it is very appropriate for rebuilding neck, roof of mouth, and tonsils cavity. The radial forearm free flap converts into a white color when it is placed inside the mouth. As these flaps have hair follicles in them so in some cases hair has been grown which totally depends upon the nature of the flap. In patients that have taken radiotherapy the chance of hair growth is finished otherwise it is removed because it causes problem to the patient (Chandu et al, p. 4).
The techniques used in the treatment of weaken or damaged tissues are relatively of great importance. When the doctor has no idea from where and how many tissues are removed than the procedure is canalized from these reasons which are firstly, to close the hole by attaching the tongue with the mouth and secondly it is done by using the procedure of local flaps or free flaps. The procedures of the real-time MRI are of great importance as it covers the whole mouth from lips to larynx, because in some cases it is difficult to find the place of damage. It is not attached to the tongue so it is very good for the patients who have severe pain (MADY et al, p. 1).
An experiment was conducted in patients who had oral cavity cancer. The people included in this examination mostly had the front and side cancer of the oral cavity in which the tongue and the mouth were most affected. They did not have any swollen part in the head or neck. Neither had they any problem in speaking? The data of these patients was noted twice. Firstly, some days before there surgery, and at the second time it was noted few weeks after the surgery before starting the radiotherapy. In these patients auditory was also done in each sitting. Two reasons are mentioned for doing this and they are, while doing the MR sitting a sharp voice is heard and the second reason is that after surgery it is very difficult for the patient to support the voice coming during the MR session and at the end of these sessions the patients are also said to take psychological therapies which are very helpful to boost up the patients motivation and also has a link with speech therapies after the surgery (MADY et al, pp. 1-2).
This research was done on about hundred patient ,in past it was done through MR to check the movement of the tongue by “vowel” delivery but now it is done through the imaging process which shows about eight pictures a second and a work is being done in this to increase the number of pictures per second to fifteen. A new method was described which is not only useful to the patients who had taken these sessions but also for many other patients which had same data when compared to the cancer patients. Two things were mentioned which did not have any relation with the tumor. First point was the base point of the jaw sockets; and second point was the front and lower part of the neck bone bones that support muscles of the tongue. In the center of the jaw socket and the muscle tongue a network is made and as a result a half circle is build which concludes the entire oral cavity that is affected by the disease. Them from the network made, two points are marked on the tongue in such a way that the distance from the roof of mouth is equal to the maximum expansion of the tongue. It is noted that in offsetting expansions lips play an important role so the distance of the lip is noted from the lip swelling and by both lips (MADY et al, p. 2).
From this observation we can check the moves of the tongue, maximum expansion of the tongue these points provide a good help in the speech sessions. As there are many positive changes being made in the field of MR so it is very helpful in the betterment of the patients and also provide them a good quality of life (MADY et al, pp. 3-4).
Microsurgical procedures are very helpful in the removal of tumors which are present in the orophraynx.but if the tumor is very big then it is quite difficult to have an accurate re building. Oral cavity and throat have a very important role in the human body, which includes “aeration, speech, taste, nutrition”. If some one has oral or throat tumor he has a great problem in these functions. Therefore, when these tissues are being re build, the main task is to provide these basic requirements to the patient. In this process, the volume and thickness of the tissues are most important, to cover the defected area (Lew et al, p. 1).
This research was concluded between 44 patients who had oropharyngeal cancer. At first the procedure of radial forearm free flaps were done and the size and place were also noticed. From this the tumor was divided in six portions. Then four different shapes of free flaps were made and implanted to the patients. After the surgery test was conducted in these patients who were about the chewing, swallowing and speech test to check the ability of the reconstruction. In 5 cases there was some sort of speech disability (Lew et al, pp. 2-3).
Any kind of problems was not seen during these surgeries. In two patients some minute opening of holes were seen. But it was closed by the passage of time. None of the patient had any further damage while chewing.but in two other patients there was some carbuncle found in the back portion of the tongue. This was cured with the passage of time. The function of the tongue was as good as the function of a normal tongue within three months after the operation (Lew et al, pp. 3-4).
Most important procedure in this reconstruction is the process of swallowing which is called “deglutition”. This further has three parts in the first part some food in placed inside the mouth and is crushed by the jaws and the front part of the tongue. In the second part called the oral part, a round soft lump is pushed by the tongue. In the last part, this soft lump is pushed inward towards the pharynx. During this time the inferior part of the tongue is touching the sides of the throat. In the reaction of this, the holes for respiration are closed and the soft lump food easily goes down the throat (Lew et al, p. 4).
This concludes that the process of re building the mouth depends on the removal of the cancer and the procedure of reconstruction done in it. The place where the surgery is done is considered much important than the quantity of tissues used. For this purpose the radial forearm free flaps is the best option (Lew et al, p. 5).
References
- A Chandu AM Bridgeman, ACH Smith, SJ Flood.
- Reconstructive techniques for the repair of oral and maxillofacial oncological procedures: What are they, how do they work and what do they look like?
- School of Dental Science, the University of Melbourne, 711Elizabeth Street, Melbourne, Victoria 3000. 2 2001
- K.MADY, R.SADER, A.ZIMMERMANN, Ph.BEER, H.F.ZEILHOFER, Ch.HANNIG, Use of real-time MRI in assessment of consonant articulation before and after surgery and tongue reconstruction.
- Department of Phonetics and Linguistic Communication, Ludwig Maximilian University, Munich. Department of Oral and Maxillofacial Surgery, University of Technology, Munich.
- Department of Radiology, University of Technology, Munich
- Dae-Hyun Lew, Eun-Chang Choi, Kwan-Chul Tark Standardization of Flap Design for Oropharyngeal Reconstruction after Cancer Ablation Surgery
- Department of Plastic and Reconstructive Surgery and Otolaryngology, Yonsei University College of Medicine.Seoul.Korea, 2003