A modified pull-through approach with a pedicled bone flap for oral and oropharyngeal cancer resection - a cadaveric feasibility study

Abstract

Abstract Purpose Compromised swallowing and speaking as well as local complications are the major disadvantages of established approaches to the posterior tongue and oropharynx. The mandibular split involves an esthetically unpleasant bipartition of the lower lip and is prone to bony non-union or sequestration. The traditional pull-through technique on the other hand lacks the safe reattachment of the lingually released soft tissues. Methods The feasibility of a new modified pull-through approach was tested on three anatomical specimens. CAD/CAM cutting guides were used to design a retentive bone flap for the proper refixation of the genioglossus and geniohyoid muscles after the procedure. Results Precise repositioning and dynamic compression of bony segments was reproducible and no injury to adjacent structures occurred. In all cases, a median lingual foramen was found and in two cases vessels entering it could be dissected. Conclusion The method presented is safe and easy to perform. Individual cutting guides improve the safety and accuracy of the procedure, potentially eliminating the need for osteosynthesis. We provide the anatomical and radiologic basis for clinical evaluation of this pedicled bone flap procedure.