Prelaminated temporal fascia free flap for reconstruction of the floor of the mouth

Abstract

Background: Mucosal defects after resection of the malignant disease in oral cavity can be left to heal by secondary intention, covered with free skin grafts or covered with local, regional or microvascular flaps. Decision about reconstruction depends on the defect size, quality of surrounding tissues and the patient’s general health condition. The goal of reconstruction is to achieve elastic, soft and moist surrounding, which enables the functioning of the remaining structures in the oral cavity as well as a rapid functional and social rehabilitation. Methods: At the beginning of patient’s diagnostic workup, two pieces of clinically healthy buccal mucosa were harvested and transferred as free mucosal grafts under superficial temporal fascia. After three weeks, squamous carcinoma of the floor of the mouth was resected and mucosal defect was reconstructed with a prelaminated temporalis fascia microvascular flap. Results: Presented and discussed is a reconstruction of the oral mucosa defect rarely described in the literature. Conclusion: There is no ideal replacement for the oral mucosa. Scar as a result of healing by secondary intention prevents tongue mobility. The quantity of mucosa available for local flaps is limited. Oral cavity environment is not ideal for healing of split-thickness skin grafts and skin transferred into oral cavity is never accustomed to the local conditions. With buccal mucosa prelaminated temporal fascia, microvasculary transferred into the oral cavity, offers a valuable method of reconstruction of medium-size mucosal defects of the oral cavity in selected, motivated patients.