Title : Wide resections of tumors of the zygomatic-maxillary complex with new reconstruction techniques with microvascularized fibular flap
Abstract:
Can lack of adherence to prevention be a factor contributing to large resections of mouth tumors and forcing the creation of new techniques for reconstruction purposes?” DIRSCHNABE... SASSI, 2020, showed patients with actinic cheilitis on the lip where the percentage of CANCER was 12.5%. Prevention is combined with the control of the emergence mainly of oral cancer, which we have observed in the estimate of the National Cancer Institute (INCA - 2023). In the State of Paraná - Brazil, there was a decrease in new cases of mouth cancer in the estimate in the 2023/2025 triennium compared to the 2018/2019 biennium. According to Sassi, et al 2024, there was an emphasis on oral cancer prevention since 1989, almost four decades in the State of Paraná, corroborating the INCA data. We can believe that large resections of the facial bones are linked to failure to prevent mouth lesions. They are extended to the prevention of adverse effects of radiotherapy and especially osteoradionecrosis (SCHEPANSKI; ,..; SASSI; ARAUJO, 2024). The resection of facial tumors that affect the maxilla, mandible and zygomatic complex has left significant sequelae and it seems to us that they make surgeons more sensitive to their destruction. Each surgical procedure is a challenge, especially when there is a large reconstruction to be performed due to the anatomical defect created by the resection of cancer in the head and neck region, or left by osteoradionecrosis, which motivates the development of new reconstruction techniques. The possibility of using microvascular flaps for reconstruction has improved the quality of life of cancer patients. Facial bone reconstruction with a microvascularized fibular flap is a routine procedure in our institution, which often leads us to seek alternatives to provide greater comfort to patients, covering issues of return to phonation, aesthetics, and function of the stomatognathic system, which is a challenge for each patient, since the main objective is to improve the patient's quality of life and provide reintegration into society. METHOD: 1- For patients who require complementary therapy with radiotherapy, there is a safety period to perform or indicate radiotherapy treatment. With the variables of greater contact surface between the segments, which facilitates bone neoformation and flap stability, thus reducing the chance of loss of bone segments or necrosis. 2- (New technique) After collecting the free fibular flap in the standard form, differentiated osteotomies, modeling (prototyping) and arrangement of the fibular bone segments are performed in the recipient site of the middle third of the face (SASSI, 2022) RESULT: This variable in the reconstruction technique of the microvascularized fibula flap left a satisfactory result for the masticatory function, phonation and aesthetics of the stomatognathic apparatus. We contributed to the return of the anatomical function of the maxilla, the zygomatic complex, in addition to aiding in the recovery of newly formed bone tissue. CONCLUSIONS: This new technique contributes mainly when we fail to prevent oral cancer and the adverse effects of radiotherapy, where great mutilation occurs in the areas and we are obliged to treat and reconstruct it. The technique presented has the advantage of requiring only one flap in the reconstruction, thus solving the technical difficulties of the middle third of the face. It is believed that the technique described can contribute to the return of the anatomical function of the patient's maxilla and zygomatic complex, in addition to helping in the recovery of newly formed bone tissue.