1. Bone-anchored Mucosal Flap
Reconstructive alternative for gingiva and flour of mouth
Jan Akervall, MD, PhD
Michigan Otolaryngology Surgery Associates (MOSA)
Medical Director
Head and Neck Multidisciplary Clinic

2. Defects
Resection of gingiva + anterior floor of mouth + partial mandibulectomy
T2 and small T4

3. Standard of care
Surgery
Postop radiation w or w/o chemo

4. Reconstructions today
Free microvascular forearm flap
Bilateral nasolabial regional flaps
Regional platysma flap

5. Free microvascular forearm flap

6. Free microvascular forearm flap

7. Free flaps, drawbacks Time consuming – high costs
Risk for flap failures
Complex postoperative care
Cosmetic (donor site morbidity)
Scaring
Functional
Speech
Swallowing
Sensation

8. Bilateral nasolabial flap

9. Bone-anchored mucosal flap
Aim
- Improve functional result
- Improve cosmetic result
- Minimize OR time
- Minimize postoperative care
- Unchanged oncologic outcome

10. 1. Preparation
Mucosal flap
.....
Drilled wholes
In the mandible

11. 2. In-set Mucosal flap brought down over the defect Anchor the flap
to the mandible
with resorb. sutures

13. M/62 y, 5x4x2

14. M/62 y, 5x4x2, 2 mo postop

15. Sex/age Site Stage Defect (cm)
___________________________________________
1 F/84 FOM T2N0 5 x 4 x 2
2 M/82 FOM T2N0 4 x 3 x 1,5
3 M/81 FOM T2N2C 5 x 3,5 x 2
4 M/61 Gingiva T2N0 4 x 3 x 2
5 M/62 FOM T2N0 5 x 4 x 2
6 M/70 FOM T2N0 5 x 3 x 2
7 M/65 FOM T2N1 4 x 3 x 2
8 M/54 Gingiva T2N0 5 x 3 x 2

16. F/84 y, 5x4x2, 1 y postop

19. M/82, 4x3x1,5, 1 y postop

20. M/81, 5x3,5x2, 1 y postop

21. M/61, 4x3x2, 1 y postop

22. Postoperative care NPO for 2 days (tube feeding only)
Clear liquids day 3
Mechanical soft food day 4
Hospitalized for 4-5 days

23. Pat Tongue Speech Swallow Scar Sensibil.
Mobil in flap
________________________________________________
(+) ++
(+) ++
OR +++
(+) +++

24. Bone anchored mucosal flap Conclusions
Short OR time (<1 h for reconstruction)
No donar site morbidity
Short postoperative care (3-5 days)
Minimal scaring
Normal – slightly impaired tongue mobility
Normal speech/swallowing

25. Bone anchored mucosal flap indications
Anterior and lateral floor of mouth/ gingiva
T2 or small T4

26. Questions?