Skip to main content

Advertisement

SpringerLink
Log in

‘AJ’s Orbicularis Oris Stitch: A Novel and Simple Technique of Reconstructing Central Arch Mandibular Defects in Resource-Constrained Set Up’

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Lip and oral cavity SCC account for 2nd highest incidence of cancers and 3rd most common cause of mortality from cancer in India. Reconstruction of defects of central arch invading cancers results in poor cosmetic and functional outcomes if free flaps are not used. 30 patients with Oral SCC in the age group 20–75 years requiring central arch segmental mandibulectomy were included. Reconstruction was done with pedicled bipaddled PMMC flap with ‘AJ’s orbicularis oris stitch’ using Fiber wire. Patients were divided into 4 groups according to extent of lip and skin loss post excision of primary tumour. Patients were evaluated with subjective scores for drooling, oral competence and cosmesis. There were 4, 12, 9 and 5 patients in Group A, B, C and D respectively. Mean subjective scores using our technique for drooling, oral competence and cosmesis were 3.75/4,3.75/4 and 3.5/4 for group A, 3.45/4, 3.36/4 and 3.09/4 for group B, 2.8/4, 2.6/4 and 2.3/4 for group C defects and 2.5/4, 3/4 and 2.5/4 for group D defects respectively. Over all scores for all patients were 3.2/4, 3.14/4 and 2.84/4 for drooling, oral competence and cosmesis. This simple, quick and inexpensive technique of reconstruction of central mandibular arch defects can drastically improve cosmetic and functional outcomes in a resource restrained set up. However, long term results and comparison studies are required for standardisation of the technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

OSCC:

Oral squamous cell carcinoma

SCC:

Squamous cell carcinoma

GBS:

Gingivo buccal sulcus

PMMC:

Pectoralis major myocutaneous flap

RT:

Radiotherapy

CTRT:

Concurrent chemoradiotherapy

NACT:

Neoadjuvant chemotherapy

UHMWPE:

Ultra high molecular weight polyethylene

References

  1. Globocan india 2020

  2. Singh MP, Kumar V, Agarwal A, Kumar R, Bhatt ML, Misra S (2016) Clinico-epidemiological study of oral squamous cell carcinoma: A tertiary care centre study in North India. J Oral Biol Craniofac Res 6(1):31–34. https://doi.org/10.1016/j.jobcr.2015.11.002. (Epub 2015 Dec 4. PMID: 26937366; PMCID: PMC4756063)

    Article  PubMed  Google Scholar 

  3. Borse V, Konwar AN, Buragohain P (2020) Oral cancer diagnosis and perspectives in India. Sens Int 1:1000. https://doi.org/10.1016/j.sintl.2020.100046. (Epub 2020 Sep 24. PMID: 34766046; PMCID: PMC7515567)

    Article  Google Scholar 

  4. Das PK, Robb GL (2017) Central arch mandibular reconstruction after surgery of oral carcinoma: an observational experience at MDACC, Houston, Texas, USA. Int J Res Med Sci 5:2412–2418

    Article  Google Scholar 

  5. Arias-Gallo J, Maremonti P, Gonzalez-Otero T, Gomez-Garcia E, Burgueno-Garcia M, Chamorro Pons M et al (2004) Long term results of reconstruction plates in lateral mandibular defects. Revision of 9 cases. Auris Nasus Larynx 31:57–63

    Article  PubMed  Google Scholar 

  6. Shibahara T, Noma H, Furuya Y, Takaki R (2002) Fracture of mandibular reconstruction plates used after tumor resection. J Oral MAxillofac Surg 60:182–185

    Article  PubMed  Google Scholar 

  7. Rajan S, Akhtar N, Kumar V, Gupta S, Misra S, Chaturvedi A, Prakash P, Azhar T (2020) A novel and simple technique of reconstructing the central arch mandibular defects—a solution during the resource-constrained setting of COVID crisis. Indian J Surg Oncol 11(Suppl 2):313–317. https://doi.org/10.1007/s13193-020-01233-0. (Epub 2020 Sep 25. PMID: 33013103; PMCID: PMC7518401)

    Article  PubMed  PubMed Central  Google Scholar 

  8. Boyd JB, Gullane PJ, Rotstein LE, Brown DH, Irish JC (1993) Classification of mandibular defects. Plast Reconstr Surg 92(7):1266–1275 (PMID: 8248401)

    CAS  PubMed  Google Scholar 

  9. Nelson K, Lewis D (2001) The testing of polyester and polyblend sutures. Report April 2001

  10. STS Study, Intracutaneous (Intradermal) Reactivity Test, Jan 2001

  11. Jain P, Rathee M (2022) Anatomy, head and neck, orbicularis oris muscle. In: StatPearls. StatPearls Publishing, Treasure Island. PMID: 31424753

  12. Rajan S, Prakash P, Akhtar N, Kumar V, Gupta S, Chaturvedi A, Mahajan D, Srivastava R, Qayoom S, Chakrabarti D, Parveen S (2021) Surgical outcomes in oral cancer involving the central arch of the mandible in elderly patients: An institutional experience. Natl J Maxillofac Surg 12(1):72–77. https://doi.org/10.4103/njms.NJMS_114_20. (Epub 2021 Mar 16. PMID: 34188404; PMCID: PMC8191556)

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gou L, Yang W, Qiao X, Ye L, Yan K, Li L, Li C (2018) Marginal or segmental mandibulectomy: treatment modality selection for oral cancer: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 47(1):1–10. https://doi.org/10.1016/j.ijom.2017.07.019. (Epub 2017 Aug 18. PMID: 28823905)

    Article  CAS  PubMed  Google Scholar 

  14. Misra S, Chaturvedi A, Misra NC (2008) Management of gingivobuccal complex cancer. Ann R Coll Surg Engl 90(7):546–553. https://doi.org/10.1308/003588408X301136. (Epub 2008 Aug 12. PMID: 18701010; PMCID: PMC2728300)

    Article  PubMed  PubMed Central  Google Scholar 

  15. Delacure M (2007) Reconstruction of mandible. Indian J Plast Surg 40:28–34

    Google Scholar 

  16. Aslam QMAM, Shahana KA (2020) Assessment of quality of life after arch preserving segmental mandibulectomy in patients reconstructed with PMMC or free fibula flap. Int J Surg Sci 4(2):27–31. https://doi.org/10.33545/surgery.2020.v4.i2a.393

    Article  Google Scholar 

  17. Deo SVS et al (2011) P236. Management of central arch mandibular squamous cell carcinoma in a resource constrained population—challenges and solutions. Oral Oncol 1(47):S149–S150

    Google Scholar 

  18. Patil S. Reconstruction plating in oncological arch mandibular resections revisited with technical modifications

  19. Hsing CY, Wong YK, Wang CP, Wang CC, Jiang RS, Chen FJ et al (2011) Comparison between free flap and pectoralis major pedicled flap for reconstruction in oral cavity cancer patients-a quality of lifeanalysis. OralOncol 47(6):522–527

    Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. MCh Surgical Oncology, GCRI, Ahmedabad, India

    Ajinkya Pawar, Jebin Aaron, Salahudheen Thottiyen, Sonal Trivedi, Kanika Kapur, Vivek Bande, Nikunj Patel, Poojitha Yalla & Gautami Joshi

  2. Department of Surgical Oncology, GCRI, 1, Krushnapark Society, Karelibaig, Vadodara, Ahmedabad, Gujarat, 390018, India

    Priyank Rathod, Vikas Warikoo, Mohit Sharma, Shashank Pandya & Shivam Pandya

  3. Orthopaedic Oncosurgeon, GCRI, Ahmedabad, India

    Abhijeet Salunke

Authors
  1. Ajinkya Pawar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Priyank Rathod
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vikas Warikoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohit Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Abhijeet Salunke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shashank Pandya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shivam Pandya
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jebin Aaron
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Salahudheen Thottiyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sonal Trivedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kanika Kapur
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Vivek Bande
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Nikunj Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Poojitha Yalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Gautami Joshi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Priyank Rathod.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pawar, A., Rathod, P., Warikoo, V. et al. ‘AJ’s Orbicularis Oris Stitch: A Novel and Simple Technique of Reconstructing Central Arch Mandibular Defects in Resource-Constrained Set Up’. Indian J Otolaryngol Head Neck Surg 75, 3703–3710 (2023). https://doi.org/10.1007/s12070-023-04044-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-023-04044-1

Keywords

Search

Navigation