Reconstruction After Oral Tumour Resection

Post-tumour resection defects refer to structural and soft tissue defects left behind after the surgical excision of benign or malignant tumours in the oral and maxillofacial region. The extent of the defect depends on the tumour’s size, location, and depth. Such resections can affect the mandible, maxilla, oral mucosa, tongue, or facial skin, creating both functional and aesthetic deficits. Reconstruction after oral tumour plays a vital role not only in the treatment of oncologic diseases but also in helping patients regain essential daily functions and a sense of normalcy in their appearance.

Unlike orthognathic or cosmetic maxillofacial surgery, which are often elective, reconstructive surgery after tumour resection is typically medically necessary. These surgeries involve more complex tissue and bone deficits and often require the collaboration of multiple specialties. Reconstructive surgery focuses on replacing lost anatomy rather than adjusting existing structures.

The purpose of reconstructive surgery after tumour resection is to:

• Restore oral and facial function (eating, speaking, breathing)
• Maintain or restore facial aesthetics
• Prevent long-term complications such as misaligned jaws or speech difficulties
• Support psychological and social reintegration

Why Cuba

Reconstructive surgery following oral tumour resection in Cuba is focused on restoring both function and facial structure, addressing the complex challenges that arise after partial or extensive removal of the jaw, oral cavity, or surrounding soft tissues. The goal is to rehabilitate the patient’s ability to chew, speak, and swallow, while also preserving or reconstructing facial symmetry and aesthetics.

Cuban surgical teams emphasize precise restoration of bony and soft tissue architecture, often involving complex procedures such as microvascular free flap transfers, bone grafting, and tissue engineering. These surgeries are guided by principles that prioritize preservation of neurovascular structures, maintenance of soft tissue integrity, and long-term prevention of complications such as infection, malocclusion, or disfigurement.

The country’s integrated healthcare system supports a multidisciplinary approach, with oral and maxillofacial surgeons working closely with oncologists, anesthesiologists, ENT specialists, prosthodontists, speech therapists, and mental health professionals. This coordinated framework ensures that post-tumour reconstruction is not limited to surgical intervention alone, but forms part of a holistic care pathway aimed at full physical, functional, and psychological recovery.

Timing of Reconstruction

• Immediate reconstruction: Carried out during the same operation as tumour removal to prevent further complications and reduce recovery time.
• Delayed reconstruction: Performed weeks or months later due to infection, extensive resection, or patient condition.

Types of Post-Tumour Resection Defects

Various types of tumours affecting the oral and maxillofacial region may necessitate surgical resection followed by reconstruction. The underlying cause plays a crucial role in determining the extent of tissue removal and the complexity of the reconstruction process.

• Malignant tumours (e.g., oral cancers):
  These are cancerous growths that can invade surrounding tissues and metastasize. Surgical removal often requires excising both the tumour and a margin of healthy tissue, which can result in significant structural and functional deficits.

• Benign but aggressive tumours (e.g., ameloblastoma):
  Though non-cancerous, these tumours can grow extensively and destroy surrounding bone and soft tissue. Their treatment often mimics that of malignant tumours due to their locally invasive nature.

• Tumours requiring wide surgical margins:
  Certain tumours, whether benign or malignant, demand the removal of additional healthy tissue around the lesion to ensure complete excision and reduce recurrence risk. This approach increases the likelihood of complex defects that require reconstructive surgery.

Post-tumour resection defects in the oral and maxillofacial region can vary in complexity depending on the location, size, and type of tumour removed.

• Soft Tissue Defects
  • Involves the removal of the tongue, cheek lining, palate, or floor of the mouth.
  • Often results in difficulty with speech, swallowing, and facial movement.

• Bony Defects
  • Partial or total loss of the mandible (lower jaw) or maxilla (upper jaw).
  • Leads to facial asymmetry, loss of dental support, and impaired mastication.

• Combined Hard and Soft Tissue Defects
  • Complex resections involving both bone and surrounding tissues.
  • Common in extensive oral cancers or advanced maxillofacial tumours.

Conditions Commonly Requiring Reconstruction After Tumour Resection

Several serious medical conditions can lead to the need for reconstructive surgery following tumour removal in the oral and maxillofacial region. These cases often involve significant tissue loss or disruption that compromises essential functions such as speaking, chewing, and facial expression, making reconstruction a vital part of recovery.

• Oral Squamous Cell Carcinoma
  Most common type of oral cancer requiring partial removal of the jaw, tongue, or soft tissue.

• Ameloblastoma
  A benign but locally aggressive tumour of the jaw, often requiring segmental mandibulectomy.

• Osteosarcoma or Chondrosarcoma of the Jaw
  Malignant bone tumours that typically require radical resection and subsequent bony reconstruction.

• Salivary Gland Tumours
  Tumours affecting the parotid, submandibular, or minor salivary glands may require soft tissue repair or facial nerve reconstruction.

• Maxillary Sinus Tumours
  May result in defects involving the orbital floor, hard palate, and adjacent facial structures.

• Recurrent or Radiation-Induced Tumours
  Secondary surgeries following failed radiation therapy often lead to compromised tissue needing reconstruction.

• Post-Resection Osteonecrosis

Particularly in patients who received radiotherapy or bisphosphonate therapy, resulting in exposed, non-healing jawbone.

Symptoms Indicating Reconstruction Procedure

After the surgical removal of an oral tumour, patients may experience a range of functional and aesthetic symptoms that signal the need for reconstructive surgery to restore normal appearance and critical oral functions. Those include:

• Difficulty speaking or slurred speech
• Impaired chewing or inability to eat solid foods
• Drooling due to loss of lip or cheek function
• Nasal regurgitation if the palate is involved
• Facial asymmetry or visible deformity
• Chronic pain or discomfort at the resection site
• Inability to wear dentures or prosthetics
• Emotional distress or reduced self-confidence due to facial changes

Presurgical Diagnosis

A thorough presurgical diagnostic process is essential in planning successful reconstruction after oral tumour resection. This step ensures not only complete removal of cancerous tissue but also allows the surgical team to anticipate and address the patient’s functional and aesthetic rehabilitation needs.

• Complete Oncologic Workup:
  Includes a detailed biopsy and histopathological evaluation to confirm the tumour type, grade, and margins. This helps determine whether reconstruction can be performed immediately after resection or needs to be staged.

• Imaging Studies:
  Imaging such as CT scans, MRIs, and panoramic X-rays are performed to assess the extent of the tumour, its involvement with bone and soft tissues, and to map critical anatomical landmarks. These images also aid in virtual surgical planning.

• Functional Assessments:
  Evaluations of speech and swallowing functions help establish a baseline and identify areas likely to be affected by tumour removal. These assessments guide the reconstructive strategy to preserve or restore vital functions.

• Dental and Occlusal Analysis:
  Assessment of the patient’s bite (occlusion), dental alignment, and remaining dentition is necessary to plan for prosthetic rehabilitation and ensure proper jaw function post-surgery.

• Multidisciplinary Evaluation:
  Collaborative planning with oncologists, oral and maxillofacial surgeons, prosthodontists, speech therapists, and nutritionists ensures that the surgical plan addresses all aspects of the patient’s care—oncologic control, functional recovery, and aesthetic outcome.

Surgical Options

Reconstruction following oral tumour resection aims to restore both the form and function of the oral and maxillofacial region. The choice of surgical technique depends on the size, location, and type of defect, as well as the patient’s overall health and rehabilitation goals. Below are the primary surgical options used:

• Local Flap Reconstruction
  This procedure uses tissue adjacent to the defect site.
  • Application: Suitable for small to moderate soft tissue defects, such as those in the cheek or lip.
  • Advantages: Good tissue match, preserves blood supply, and is relatively simple procedure.
  • Limitations: Limited by tissue availability and may not be suitable for extensive defects.

• Regional Flap Reconstruction
  This procedure transfers tissue from a nearby region with its blood supply, such as the pectoralis major flap or temporalis muscle flap.
  • Application: Often used when local tissue is insufficient or unavailable.
  • Advantages: Robust vascular supply, suitable for larger or deeper defects.
  • Limitations: May result in donor site morbidity or less aesthetic outcomes.

• Free Flap Reconstruction (Microvascular Surgery)
  In this procedure tissue (skin, muscle, bone) is transferred from distant parts of the body, reconnected via microvascular anastomosis.
  • Common Free Flaps:
    • Fibula Free Flap: For mandibular reconstruction (bone and soft tissue).
    • Radial Forearm Free Flap: For intraoral soft tissue defects.
    • Anterolateral Thigh Flap: Versatile option for bulkier soft tissue defects.
    • Scapular or Iliac Crest Flaps: Used when large bone segments are required.
  • Advantages: Highly customizable, ideal for complex or composite (bone and soft tissue) defects.
  • Limitations: Technically demanding, longer surgical time, requires specialized surgical teams.

• Bone Grafting
  This procedure involves the placement of autologous (from the patient), allogenic (donor), or synthetic bone to reconstruct bony structures.
  • Application: Used in patients who are not candidates for free flaps or as a secondary reconstruction phase.
  • Advantages: Restores jaw continuity and prepares for dental implants.
  • Limitations: Risk of graft resorption, limited structural support compared to vascularized flaps.

• Alloplastic Materials and Implants
  This procedure uses biocompatible synthetic materials to replace missing bone or support soft tissues.
  • Application: Often used in conjunction with or as an alternative to bone grafting.
  • Advantages: Immediate availability, avoids donor site morbidity.
  • Limitations: Higher risk of infection or rejection, not ideal for irradiated tissue beds.

• Dental and Maxillofacial Prosthetics
• This procedure involves the placement of obturators, dental implants, or facial prostheses after surgical reconstruction.
  • Application: Complements surgical reconstruction by restoring oral function and aesthetics.
  • Advantages: Customizable and non-invasive.
  • Limitations: May require adjustments overtime and regular follow-up.

Each reconstructive strategy is tailored to the patient’s unique condition and goals, often involving a staged approach and coordination with prosthodontists and rehabilitation specialists. The ultimate aim is to achieve the best possible outcome in terms of speech, mastication, aesthetics, and quality of life.

Minimally Invasive vs. Open Approaches

• Open surgery is standard due to the complexity and size of defects
• Minimally invasive techniques (e.g., endoscopic flap harvesting) may be applied in select stages