“A PROSPECTIVE AND COMPARATIVE STUDY OF CARCINOMA OF BUCCAL MUCOSA CASES WITH EXCISION FOLLOWED BY PRIMARY CLOSURE VERSUS USE OF RECONSTRUCTIVE FLAP”

Abstract

Introduction: Carcinoma of buccal mucosa is the most common cancer of the oral cavity in India.1 Increasing trend of incidence of these cancers in the developing countries, most likely due to a higher exposure to alcohol, tobacco, health ignorance, poor access to health care facilities. Buccal mucosa cancers primarily occurs along the occlusal plane and are characterized by pain and ulceration, which are usually accompanied by a buccal mass. Aim: To compare the clinical outcome in cases of surgery with primary closure and surgery with reconstructive aps after standard surgery for extirpation of tumor. Material And Method: The study was carried out as a prospective study in the Department of General Surgery at Gajra Raja Medical College and J.A. Group of Hospitals, Gwalior (M.P.) for one and half year from January 2020 to June 2021.Atotal of 30 patients with histopathologically conrmed carcinoma of buccal mucosa were studied. The study was approved by ethical committee of the Hospital. Results: In the present study, the result of primary closure vs ap reconstruction for defects extirpation of tumor, the maximum cases lie in age group of 41- 50 years (12 i.e. 40%) age group of 61-70 years (6 i.e. 20%) and 51-60 years (5 i.e. 17%). Carcinoma of buccal mucosa had higher incidence in male. Total number of male cases were 26(87%) and female cases were 4(13%).The male to female ratio was 6.5:1. Out of 30 patients, in 18 cases neck management done by modied radical neck dissection and in 11 cases neck managed by radical neck dissection. After resection of primary lesion and neck dissection, the defect which was either covered by use of reconstructive ap or primary closed. Out of 30 cases, in 18 cases defect was closed by use of reconstructive ap and in 12 cases defect was primary closed. Out of 30 cases, in 13 cases(72%) reconstruction was done by use of pectoralis major myocutaneous ap. In 3 cases(17%), reconstruction was done by use of free bular graft and in 2 cases(11%), reconstruction was done by use of Radial forearm free ap. Conclusion: In carcinoma buccal mucosa, No neck patients was treated with modied radical neck dissection and N+ neck patients was treated by Radical neck dissection. Eleven carcinoma buccal mucosa underwent Radical neck dissection and 18 patients had Modied radical neck dissection. For Mandible reconstruction, bular bone graft is best option for form and function. Two patients underwent mandibular reconstruction by use vascularized bular bone. Primary closure of defect was possible if surrounding tissue was lax. Primary closure after excision of tumor done in 12 cases(40%). In buccal mucosa carcinoma, free ap provides reconstruction for complex defect. In present study, Pectoralis major myocutaneous ap mostly used for reconstruction of defect. In 13 patients (72%) PMMC ap was used. The complication noted was, immediate was ap necrosis and late was recurrence. In immediate post operative period there was ap necrosis in 2 cases and recurrence was seen in 4 cases.