Oral Reconstruction

  • J. Collin
  • B. Turner
  • R. FernandesEmail author


A successful outcome in oral cancer surgery is firstly determined by adequate oncologic resection with clear margins and secondly reconstruction of the resultant defect that restores both form and function. This chapter focuses on the latter objective. Subsites of the oral cavity (lip, cheek, tongue, floor of mouth, mandible, and maxilla) are discussed according to function, morbidity, and reconstructive options, which are organized from simplest to most complex.

Arguably the greatest challenge of oral cancer surgery is reconstruction that restores the patient’s premorbid quality of life. True oral cavity malignancies, as distinguished from those arising in the oropharynx, are typically amenable to resection with acceptable oncologic outcome. However, the functional aspects of the oral cavity are among the most important in the body and are extremely sensitive to alteration resulting from even an apparently small resection. The mouth is of critical importance for both nutrition (mastication and deglutition) and social interaction (speech, facial expression), two of the most basic functions on which quality of life depends. All these functions depend on the anatomic integrity and coordinated action of organs within a very small tissue volume. Oral squamous cell carcinoma, the typical malignant pathology requiring resection from the oral cavity, is ideally resected with a 1 cm margin in all directions, more than doubling the volume resected for lesions up to 2.5 cm in diameter. Many patients present with oral malignancies of a size requiring significant resection even before these margins are applied.


Oral cancer reconstruction 


  1. 1.
    Ray E. Head and neck reconstructive surgery. In: Cancer treatment and research. New York, NY: Springer; 2018. p. 123–43. Accessed 3 Sep 2018.Google Scholar
  2. 2.
    Erba P, Ogawa R, Vyas R, Orgill DP. The reconstructive matrix: a new paradigm in reconstructive plastic surgery. Plast Reconstr Surg. 2010;126(2):492–8.PubMedCrossRefGoogle Scholar
  3. 3.
    El-Marakby HH. The reliability of pectoralis major myocutaneous flap in head and neck reconstruction. J Egypt Natl Canc Inst. 2006;18(1):41–50. Accessed 31 Aug 2018.PubMedGoogle Scholar
  4. 4.
    Shah JP, Haribhakti V, Loree TR, Sutaria P. Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg. 1990;160(4):352–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Zitelli JA. Wound healing by secondary intention. A cosmetic appraisal. J Am Acad Dermatol. 1983;9(3):407–15.PubMedCrossRefGoogle Scholar
  6. 6.
    Leonard AL, Hanke CW. Second intention healing for intermediate and large postsurgical defects of the lip. J Am Acad Dermatol. 2007;57(5):832–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Jin X, Teng L, Zhang C, Xu J, Lu J, Zhang B, et al. Reconstruction of partial-thickness vermilion defects with a mucosal V–Y advancement flap based on the orbicularis oris muscle. J Plast Reconstr Aesth Surg. 2011;64(4):472–6.CrossRefGoogle Scholar
  8. 8.
    Wagner DJD, Newman DMH. Bipedicled axial cross-lip flap for correction of major vermilion deficiency after cleft lip repair. 2017. Scholar
  9. 9.
    Ceran C, Demirseren ME, Sarici M, Durgun M, Tekin F. Tongue flap as a reconstructive option in intraoral defects. J Craniofac Surg. 2013;24(3):972–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Levi B, Ricci JA, Donelan MB. Vermillion reconstruction with anal verge transitional epithelium. J Burn Care Res. 2017;39(2):1.Google Scholar
  11. 11.
    Karapandzic M. Reconstruction of lip defects by local arterial flaps. Br J Plast Surg. 1974;27(1):93–7. Accessed 31 Aug 2018.PubMedCrossRefGoogle Scholar
  12. 12.
    Sood A, Paik A, Lee E. Lower lip reconstruction: karapandzic flap. Eplasty 2013;13:ic17. Accessed 3 Sep 2018.
  13. 13.
    Bernard C. Cancer de la levre inferieure opere par un procede nouveau. Bull Mem Soc Chir. 1853;3:357–64. Scholar
  14. 14.
    Webster RC, Coffey RJ, Kelleher RE. Total and partial reconstruction of the lower lip with innervated muscle-bearing flaps. Plast Reconstr Surg. 1960;25(3):360–71.CrossRefGoogle Scholar
  15. 15.
    Pirgousis P, Fernandes R. Reconstruction of subtotal defects of the lower lip: a review of current techniques and a proposed modification. J Oral Maxillofac Surg. 2011;69(1):295–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Fujimori R. Gate for the total reconstruction of the lower lip. Br J Plast Surg. 1980;33(3):340–5. Accessed 31 Aug 2018.PubMedCrossRefGoogle Scholar
  17. 17.
    Aytekin A, Ay A, Aytekin O. Total upper lip reconstruction with bilateral fujimori gate flaps. Plast Reconstr Surg. 2003;111(2):797–800.PubMedCrossRefGoogle Scholar
  18. 18.
    Agostini T. The Sabattini-Abbé flap: a historical note. Plast Reconstr Surg. 2009;123(2):767. Accessed 3 Sep 2018PubMedCrossRefGoogle Scholar
  19. 19.
    Abbe R. A new plastic operation for the relief of deformity due to double harelip. Plast Reconstr Surg. 1968;42(5):481–3. Accessed 31 Aug 2018PubMedGoogle Scholar
  20. 20.
    Webster JP. Crescentic peri-alar cheek excision for upper lip flap advancement with a short history of upper lip repair. Plast Reconstr Surg. 1955;16(6):434–64.CrossRefGoogle Scholar
  21. 21.
    Fernandes R, Clemow J. Outcomes of total or near-total lip reconstruction with microvascular tissue transfer. J Oral Maxillofac Surg. 2012;70(12):2899–906. Accessed 3 Sep 2018.PubMedCrossRefGoogle Scholar
  22. 22.
    Sakai S, Soeda S, Endo T, Ishii M, Uchiumi E. A compound radial artery forearm flap for the reconstruction of lip and chin defect. Br J Plast Surg. 1989;42(3):337–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Cordova A, D’Arpa S, Moschella F. Gracilis free muscle transfer for morpho-functional reconstruction of the lower lip. Head Neck. 2008;30(5):684–9. Accessed 3 Sep 2018.PubMedCrossRefGoogle Scholar
  24. 24.
    Sacak B, Gurunluoglu R. The innervated gracilis muscle for microsurgical functional lip reconstruction: review of the literature. Ann Plast Surg. 2015;74(2):204–9. Accessed 3 Sep 2018.PubMedCrossRefGoogle Scholar
  25. 25.
    Gurunluoglu R, Glasgow M, Williams SA, Gurunluoglu A, Antrobus J, Eusterman V. Functional reconstruction of total lower lip defects using innervated gracilis flap in the setting of high-energy ballistic injury to the lower face: preliminary report. J Plast Reconstr Aesthet Surg. 2012;65(10):1335–42. Accessed 3 Sep 2018.PubMedCrossRefGoogle Scholar
  26. 26.
    Lyons GB, Milroy BC, Lendvay PG, Teston LM. Upper lip reconstruction: use of the free superficial temporal artery hair-bearing flap. Br J Plast Surg. 1989;42(3):333–6. Accessed 3 Sep 2018.PubMedCrossRefGoogle Scholar
  27. 27.
    Chang K-P, Lai C-S, Tsai C-C, Lin T-M, Lin S-D. Total upper lip reconstruction with a free temporal scalp flap: long-term follow-up. Head Neck. 2003;25(7):602–5. Accessed 3 Sep 2018.PubMedCrossRefGoogle Scholar
  28. 28.
    Dean A, Alamillos F, García-López A, Sánchez J, Peñalba M. The buccal fat pad flap in oral reconstruction. Head Neck. 2001;23(5):383–8. Accessed 3 Sep 2018.PubMedCrossRefGoogle Scholar
  29. 29.
    Liu F, Wang L, Pang S, Kan Q. Reconstruction of full-thickness buccal defects with folded radial forearm flaps: a retrospective clinical study. Medicine (Baltimore). 2017;96(32):e7344. Accessed 3 Sep 2018.CrossRefGoogle Scholar
  30. 30.
    Liu Z-M, Wu D, Liu X-K, Liu W-W, Li H, Li Q, et al. Reconstruction of through-and-through cheek defects with folded free anterolateral thigh flaps. J Oral Maxillofac Surg. 2013;71(5):960–4. Accessed 3 Sep 2018.PubMedCrossRefGoogle Scholar
  31. 31.
    Liu YM, Sherris DA. Static procedures for the management of the midface and lower face. Facial Plast Surg. 2008;24(2):211–5. Accessed 3 Sep 2018.PubMedCrossRefGoogle Scholar
  32. 32.
    Coyle M, Godden A, Brennan PA, Cascarini L, Coombes D, Kerawala C, et al. Dynamic reanimation for facial palsy: an overview. Br J Oral Maxillofac Surg. 2013;51(8):679–83. Accessed 3 Sep 2018.PubMedCrossRefGoogle Scholar
  33. 33.
    Martin D, Pascal JF, Baudet J, Mondie JM, Farhat JB, Athoum A, et al. The submental island flap: a new donor site. Anatomy and clinical applications as a free or pedicled flap. Plast Reconstr Surg. 1993;92(5):867–73.PubMedCrossRefGoogle Scholar
  34. 34.
    Cariati P, Cabello Serrano A, Marin Fernandez AB, Perez de Perceval Tara M, Juliá MA, Ildefonso Martinez Lara M. Is submental flap safe for the oncological reconstruction of the oral cavity? J Stomatol oral Maxillofac Surg. 2018. Accessed 29 Aug 2018.
  35. 35.
    Howard BE, Nagel TH, Donald CB, Hinni ML, Hayden RE. Oncologic safety of the submental flap for reconstruction in oral cavity malignancies. Otolaryngol Head Neck Surg. 2014;150(4):558–62. Accessed 29 Aug 2018.PubMedCrossRefGoogle Scholar
  36. 36.
    Wu Y, Tang P, Qi Y, Xu Z, He Y. Evaluation for submental island flap. Zhonghua Kou Qiang Yi Xue Za Zhi. 2002;37(6):418–20. Accessed 31 Aug 2018.PubMedGoogle Scholar
  37. 37.
    Taghinia AH, Movassaghi K, Wang AX, Pribaz JJ. Reconstruction of the upper aerodigestive tract with the submental artery flap. Plast Reconstr Surg. 2009;123(2):562–70. Accessed 31 Aug 2018.PubMedCrossRefGoogle Scholar
  38. 38.
    Deganello A, Manciocco V, Dolivet G, Leemans CR, Spriano G. Infrahyoid fascio-myocutaneous flap as an alternative to free radial forearm flap in head and neck reconstruction. Head Neck. 2007;29(3):285–91. Accessed 3 Sep 2018.PubMedCrossRefGoogle Scholar
  39. 39.
    Mosier K, Liu W-C, Behin B, Lee C, Baredes S. Cortical adaptation following partial glossectomy with primary closure: implications for reconstruction of the oral tongue. Ann Otol Rhinol Laryngol. 2005;114(9):681–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Brown L, Rieger JM, Harris J, Seikaly H. A longitudinal study of functional outcomes after surgical resection and microvascular reconstruction for oral cancer: tongue mobility and swallowing function. J Oral Maxillofac Surg. 2010;68(11):2690–700.PubMedCrossRefGoogle Scholar
  41. 41.
    Biglioli F, Liviero F, Frigerio A, Rezzonico A, Brusati R. Function of the sensate free forearm flap after partial glossectomy. J Cranio-Maxillofac Surg. 2006;34(6):332–9.CrossRefGoogle Scholar
  42. 42.
    Kimata Y, Sakuraba M, Hishinuma S, Ebihara S, Hayashi R, Asakage T, et al. Analysis of the relations between the shape of the reconstructed tongue and postoperative functions after subtotal or total glossectomy. Laryngoscope. 2003;113(5):905–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Weber RS, Ohlms L, Bowman J, Jacob R, Goepfert H. Functional results after total or near total glossectomy with laryngeal preservation. Arch Otolaryngol Neck Surg. 1991;117(5):512–5.CrossRefGoogle Scholar
  44. 44.
    Brown JS, Barry C, Ho M, Shaw R. A new classification for mandibular defects after oncological resection. Lancet Oncol. 2016;17(1):e23–30. Accessed 31 Aug 2018.PubMedCrossRefGoogle Scholar
  45. 45.
    Brown JS, Rogers SN, McNally DN, Boyle M. A modified classification for the maxillectomy defect. Head Neck. 2000;22(1):17–26.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Moreno MA, Skoracki RJ, Hanna EY, Hanasono MM. Microvascular free flap reconstruction versus palatal obturation for maxillectomy defects. Head Neck. 2009;32(7):860–8.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.University of Florida College of Medicine JacksonvilleJacksonvilleUSA

Personalised recommendations