The Infrahyoid Musculocutaneous Flap for the Reconstruction of Composite Oro-mandibular Defects

Abstract

Resection of advanced gingivobuccal squamous cell carcinoma results in complex posterolateral mandible and soft tissue defects. Optimal reconstruction would include a single osteocutaneous free flap. However, free flaps are not feasible in certain situations where pectoralis major musculocutaneous flap is preferred. But it is very bulky and cannot be thinned, hence suitable only for repairing very large defects. For medium-sized composite oro-mandibular defects, we used infrahyoid musculocutaneous flap in select patients and evaluated the surgical outcomes. Patients who underwent infrahyoid musculocutaneous flap reconstruction for composite oro-mandibular defects at our center from 2016 to 2021 were included. Patient and defect characteristics were evaluated from our prospectively maintained electronic medical records. Assessment of speech and swallowing function was done by our therapist. Cosmesis was assessed by an independent observer using the visual analogue scale. In our series of 11 patients, none of the flaps was lost. Two patients had partial skin paddle loss. Most of these patients had mandibular drift but none of them developed postoperative trismus. All patients resumed normal oral or soft solid diet. Speech intelligibility was normal in all patients. All patients had satisfactory cosmetic outcome. Infrahyoid musculocutaneous flap is a reliable, quicker, and safe alternative technique in select patients for the reconstruction of composite oro-mandibular defects. In our small series of select patients, speech and swallowing outcomes were excellent with great patient satisfaction.