Intraoral anastomosis for primary microsurgical reconstruction in patients of oral cavity malignancies: Retrospective analysis of 30 cases from a tertiary care center in India

Introduction In patients undergoing robotic neck dissections or no neck dissection, the neck recipient vessels for flap remain unexposed. Intraoral vessels have been successfully used as microvascular recipients but their use in intraoral malignancies is uncommon. We describe our initial experience of using intraoral recipients in 30 patients of oral cavity malignancies. Methods For this retrospective observational study, the hospital records of all patients who underwent microvascular reconstruction using intraoral recipient vessels over a 14-month period at a tertiary care hospital in India were studied. Patient demographics, disease profile, details of oncosurgical resection, reconstructive procedure details and post operative recovery data was analysed. Results Intraoral anastomosis was successfully performed in 30 patients. The average patient was middle aged (mean age 54 years) and male (26/30). Location of post excision defect was the buccal mucosa in 16/30 and tongue in 12/30 patients. Anterolateral thigh flap (ALT) was used in 28/30 patients. Recipient vessels were the facial vessels in 24/30 patients and the lingual vessels in 6/30 patients. Venous anastomotic coupler was used in 27/30 patients. Three patients underwent reexploration for flap congestion with loss of flap in 2/30 patients. Conclusion The intraoral approach offers consistent vascular anatomy and can be performed without any external incision and oro-cervical tunnelling. Being technically challenging, it has an initial learning phase. Adequate mouth opening and preservation of recipient vessels during excision and neck dissection are important prerequisites. This approach can offer a scarless reconstruction which can improve psycho-social rehabilitation of the patients.