Salvage Reconstruction of Composite Defects of the Anterior Mandible, Floor of Mouth, and Lip
Anterior mandible defects result in loss of support for the tongue, floor of the mouth and lower lip, resulting in impairment of airway, feeding, and speech. We treated four patients with these “Andy Gump” deformities. Reconstruction was performed with two free flaps: a fibula osteocutaneous flap fo...
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2024-09-01
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| Series: | Archives of Plastic Surgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-2263-8046 |
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| author | Farrukh A. Khalid Omar A. Ahmed Almeotan P. Khurshid Abdul M. Mujahid Junaid Ahmad Muhammad Saleem Muhammad A. Yousaf Moazzam N. Tarar Farooq Shahzad |
| author_facet | Farrukh A. Khalid Omar A. Ahmed Almeotan P. Khurshid Abdul M. Mujahid Junaid Ahmad Muhammad Saleem Muhammad A. Yousaf Moazzam N. Tarar Farooq Shahzad |
| author_sort | Farrukh A. Khalid |
| collection | DOAJ |
| description | Anterior mandible defects result in loss of support for the tongue, floor of the mouth and lower lip, resulting in impairment of airway, feeding, and speech. We treated four patients with these “Andy Gump” deformities. Reconstruction was performed with two free flaps: a fibula osteocutaneous flap for the anterior mandible and floor of the mouth, and a soft tissue free flap for the lip, chin, and anterior neck. The lower lip was suspended cranially with fascia or tendon grafts ± mini-temporalis turndown flaps. All flaps survived completely. All patients were tube feed-dependent before surgery; they all resumed an oral diet. All tracheostomies were decannulated. Lip competence was restored as evidenced by cessation of drooling. Speech improved from unintelligible to intelligible with frequent repetitions. Objective assessment was performed with the functional intraoral Glasgow scale; the mean FIGS score improved from 3.25 (range 3–4) to 11 (range 9–13). We conclude that composite anterior mandible and tongue defects have large tissue requirements that require multiple free flaps. Reconstruction leads to significant improvement in function. |
| format | Article |
| id | doaj-art-bc322603180d41af9ed7c2f41fd8c770 |
| institution | Kabale University |
| issn | 2234-6163 2234-6171 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj-art-bc322603180d41af9ed7c2f41fd8c7702024-11-20T00:29:28ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712024-09-01510549550310.1055/a-2263-8046Salvage Reconstruction of Composite Defects of the Anterior Mandible, Floor of Mouth, and LipFarrukh A. Khalid0https://orcid.org/0000-0001-9954-8890Omar A. Ahmed1https://orcid.org/0000-0001-8129-0289Almeotan P. Khurshid2https://orcid.org/0009-0009-9250-046XAbdul M. Mujahid3https://orcid.org/0000-0002-3321-5441Junaid Ahmad4https://orcid.org/0000-0002-6121-1173Muhammad Saleem5https://orcid.org/0009-0008-7375-5769Muhammad A. Yousaf6https://orcid.org/0000-0003-1567-3278Moazzam N. Tarar7https://orcid.org/0009-0007-3474-0612Farooq Shahzad8https://orcid.org/0000-0001-7758-8015Jinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, PakistanDepartment of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, United KingdomJinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, PakistanJinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, PakistanJinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, PakistanJinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, PakistanJinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, PakistanJinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, PakistanPlastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New YorkAnterior mandible defects result in loss of support for the tongue, floor of the mouth and lower lip, resulting in impairment of airway, feeding, and speech. We treated four patients with these “Andy Gump” deformities. Reconstruction was performed with two free flaps: a fibula osteocutaneous flap for the anterior mandible and floor of the mouth, and a soft tissue free flap for the lip, chin, and anterior neck. The lower lip was suspended cranially with fascia or tendon grafts ± mini-temporalis turndown flaps. All flaps survived completely. All patients were tube feed-dependent before surgery; they all resumed an oral diet. All tracheostomies were decannulated. Lip competence was restored as evidenced by cessation of drooling. Speech improved from unintelligible to intelligible with frequent repetitions. Objective assessment was performed with the functional intraoral Glasgow scale; the mean FIGS score improved from 3.25 (range 3–4) to 11 (range 9–13). We conclude that composite anterior mandible and tongue defects have large tissue requirements that require multiple free flaps. Reconstruction leads to significant improvement in function.http://www.thieme-connect.de/DOI/DOI?10.1055/a-2263-8046Andy Gumpanterior mandiblefree flapfunctional intraoral Glasgow scalelip suspension |
| spellingShingle | Farrukh A. Khalid Omar A. Ahmed Almeotan P. Khurshid Abdul M. Mujahid Junaid Ahmad Muhammad Saleem Muhammad A. Yousaf Moazzam N. Tarar Farooq Shahzad Salvage Reconstruction of Composite Defects of the Anterior Mandible, Floor of Mouth, and Lip Archives of Plastic Surgery Andy Gump anterior mandible free flap functional intraoral Glasgow scale lip suspension |
| title | Salvage Reconstruction of Composite Defects of the Anterior Mandible, Floor of Mouth, and Lip |
| title_full | Salvage Reconstruction of Composite Defects of the Anterior Mandible, Floor of Mouth, and Lip |
| title_fullStr | Salvage Reconstruction of Composite Defects of the Anterior Mandible, Floor of Mouth, and Lip |
| title_full_unstemmed | Salvage Reconstruction of Composite Defects of the Anterior Mandible, Floor of Mouth, and Lip |
| title_short | Salvage Reconstruction of Composite Defects of the Anterior Mandible, Floor of Mouth, and Lip |
| title_sort | salvage reconstruction of composite defects of the anterior mandible floor of mouth and lip |
| topic | Andy Gump anterior mandible free flap functional intraoral Glasgow scale lip suspension |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-2263-8046 |
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