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Outcome Evaluation of Mandibular Pull-Through Approach for Glossectomies

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Abstract

Patients with advanced carcinoma tongue in the Indian subcontinent have an additional component of submucosal fibrosis (SMF) due to chewing of betel. We intend to evaluate  mandibular pull-through approach for total or near-total glossectomy and assessed its functional and survival outcome. Prospective study of 77 patients with carcinoma tongue, who underwent total or near-total glossectomy at our institute, were assessed retrospectively. All the patients who underwent glossecomy through mandibular pull through approach with pedicled or free flap reconstruction were assessed for functional and survival outcomes. Of the 77 patients, 45 (58.44%) patients underwent total glossectomy, while 32 (41.55%) patients near-total glossectomy, 61 (79.22%) cases had operative time ≤ 30 min, 69 (89.61%) patients had margins of > 5 mm, and none of the margins were involved. Flaps were reconstructed with 42 (54.54%) PMMC, 24 (31.16%) FRAFF, and 11 (14.28%) ALT. Five (6.49%) patients had surgical site infections, 6 patients each had to undergo re-explorations and partial flap loss, 7 patients had oro-cutaneous fistula, while 53 (68.83%) patients had no complications/osteoradionecrosis. A total of 94% of patients underwent decannulation, 92% of patients got discharged, and 89% got NG tube removed within 21 POD. Forty patients had reasonably good speech. On the long-term follow-up, 9% of the patients developed local recurrence and 11% of patients had regional/lymph node recurrence. Mandibular pull-through approach had the advantages of good accessibility to the tumour with the least mutilating techniques with shorter operation time, lower rates of postoperative complications, and better aesthetics and based on available data, it is superior to the mandibular lip-spilt surgery for advanced tongue involving BOT and floor of mouth cancers when coupled with SMF surgeries for the Indian scenario.

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Abbreviations

SMF:

Submucosal fibrosis

POD:

Postoperative day

FOM:

Floor of mouth

MRI:

Magnetic resonance imaging

BOT:

Base of tongue

SAN:

Spinal accessory nerve

IJV:

Internal jugular vein

ALT:

Anterolateral thigh flap

FRAFF:

Free radial forearm flap

PMMC:

Pectoralis major myocutaneous flap

SSI:

Surgical site infection

OCF:

Oro-cutaneous fistula

NG:

Nasogastric

NCCN:

National Comprehensive Cancer Network

TNM:

Tumour node metastasis

SCC:

Squamous cell carcinoma

TMJ:

Temporo-mandibular joint

3D:

Three dimensional

CBCT:

Cone beam computer tomography

OS:

Overall survival

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Authors and Affiliations

  1. Department of Surgical Oncology, Sri Aurobindo Institute of Medical Sciences, Indore, MP, India

    Elroy Saldanha, Sanjay M. Desai, Dhruv G. Patel, Vinod Dhakad, Bonny Joseph & Sandeep Ghosh

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  1. Elroy Saldanha
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  2. Sanjay M. Desai
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  3. Dhruv G. Patel
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  4. Vinod Dhakad
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  5. Bonny Joseph
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  6. Sandeep Ghosh
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Correspondence to Vinod Dhakad.

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Saldanha, E., Desai, S.M., Patel, D.G. et al. Outcome Evaluation of Mandibular Pull-Through Approach for Glossectomies. Indian J Surg Oncol 12, 722–728 (2021). https://doi.org/10.1007/s13193-021-01417-2

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  • DOI: https://doi.org/10.1007/s13193-021-01417-2

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