Table Of ContentOral Cavity
Reconstruction
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Oral Cavity
Reconstruction
edited by
TERRY A. DAY
Medical University of South Carolina
Charleston, South Carolina, U.S.A.
DOUGLAS A. GIROD
University of Kansas Medical Center,
Kansas City, Kansas, U.S.A.
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This book was completed through the love, support, and patience of my
wife, Millie, and my children, Austen and Meredith. They became all too
knowledgeable about the ‘‘Oral Cavity Textbook’’ but in an entirely different
way than we as clinicians view this text! Additionally, I would like to give
credit to the authors and all physicians, dentists, and health care professionals
who have sacrificed their lives to help the lives of others stricken with head
and neck cancers through patient care, research, and education.
Terry Day
I would like to dedicate my efforts on this text to my wife Susan Girod who
strives to keep me sane and grounded through my many projects and has
done such a wonderful job with our children Katelyn, Callie and Jimmy.
I thank them all for their patience and love. I would like to thank my
professional mentor Dr. Charles Cummings for his inspiration, insight,
humor and support throughout my career and during this endeavor.
Thanks also to Heather Barnhart, RN for her tireless support and
endless compassion for the many cancer patients we have worked with
over the last 11 years who have served as the motivation for this text.
Lastly, I would like to thank the faculty, residents, students and staff
of the Department of Otolaryngology—Head and Neck Surgery at the
University of Kansas for the years of dedication and hard work for
the sake of our patients.
Doug Girod
Foreword
It is my distinct pleasure to make comment about this well-timed text regarding oral
cavity reconstruction. That this book has evolved is a testimonial to the evolution of
medical understanding, enhancement, and therapeutic planning in the multidisciplin-
ary approach to complex problems. What was once an arena of extirpation followed
by modest attempts at reconstruction, management has been transformed (through
the wonders of imaging, miniaturization, and visual magnification) to selective extir-
pation and functional as well as cosmetic reconstruction. Questions heretofore
unasked, or at least unanswered, have in many instances fallen to resolution. This
excellent work chronicles the breadth of understanding and implementation which
now exists, such that the bottom line focus of the surgical rehabilitative team focuses
on quality of life for the patient. I commend the editors for their creativity and all of
the authors for their contribution thus enhancing the welfare of our patients. For
those of us involved in treatment of advanced head/neck malignancy, this contribu-
tion comes at the right time.
Charles W. Cummings, MD
Distinguished Service Professor
Department of Otolaryngology—
Head and Neck Surgery
v
Preface
The twilight of the 20th century was a time of many advances in the management of
head and neck cancer, but perhaps none have been so dramatic as those found in the
reconstruction of defects of the oral cavity. The incidence of oral cavity carcinoma
remains tied to the usage of tobacco and alcohol products, and thus, although
preventable, is still quite prevalent. While radiotherapy has made advances as well,
surgery remains the mainstay of management of oral cavity carcinoma. Unfortunately,
surgical extirpation of oral cancers may result in significant functional and aesthetic
compromise unless appropriate reconstructive and rehabilitative approaches are
utilized. This text provides a comprehensive and detailed summary of these methods.
Unfortunately, the oral cavity is a major component of personal, professional,
and social interaction through speech, deglutition, respiration, and cosmesis. It also
serves in many aspects as a dividing line between dental and medical specialists
related to appropriate oral and dental health. These specialists from a variety of
backgrounds must collaborate in providing the optimal care for oral cancer patients.
Additionally, the impact of surgical treatment of oral cavity carcinoma can be very
profound for an individual. The success of reconstructive efforts in the oral cavity
may be the difference between the retention of an individual as a productive member
of society or complete social isolation.
Reconstructive management of oral cavity defects has now progressed beyond
primary closure and skin grafts to a variety of pedicled flaps and, more recently, to
microvascular free tissue transfers of composite flaps that can be tailor designed to
match the missing tissues. These advances arm the reconstructive surgeon with a
wide variety of options to consider when faced with an oral cavity defect. Addition-
ally, the oncologic surgeon may now consider the resection of large debilitating
tumors, which would have previously been deemed unresectable without the current
options for complex reconstruction.
With the wide variety of reconstructive techniques for the oral cavity now
available, the surgeon is faced with making choices for the repair of individual
defects. Each patient and defect of the oral cavity is unique and requires a multidis-
ciplinary approach to optimal function and cosmesis. The successful reconstructive
surgeon relies heavily on experience in making these difficult decisions, taking a
multitude of factors unique to a given situation into consideration.
Thus, the genesis of this text was to draw upon some of the most active and
experienced oral and head and neck reconstructive surgeons to outline their
approach to managing very site-specific defects of the oral cavity. A review of (i) oral
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