Abstract:
Orocutaneous fistula (OCF) after reconstruction for oral cavity resection is not uncommon and recent meta-analysis showed overall incidence of OCF to be 7.71%. Higher OCF rate was observed in patient underwent oral/oropharyngeal tumor ablation with lip-split mandibular swing approach compared to transoral approach. OCF over lower face central region was more common after lip-split mandibular swing approach compared with OCF over lower face lateral region. OCF with small to medium size could be managed non-operatively but is takes time and adjuvant treatment could be delayed. Local or regional flaps are simple and dependable surgical options with affordable sacrifice to manage OCF. Here, we provided two cases utilizing lip or chin flap along with previous scar of lip-split mandibular swing approach to manage OCF over lower face central region.
Case 1: We presented a 57-year-old man who had right lateral tongue cancer underwent tumor wide excision and left anterolateral thigh flap reconstruction 13 years ago through lip-split mandibular swing approach developed intraoral wound complication with bone exposure after concomitant chemoradiotherapy. Left nasolabial flap and right deltopectoral flap were utilized sequentially for intraoral defect reconstruction. OCF developed in 11-year-follow-up with inlet from right moth floor to outlet over right mental region. Conservative treatment for 3 months was tried but failed. Tongue flap was used but recurrent OCF developed at postoperative 6-month follow-up. This time, 2-stage operation was used to manage the right submental OCF. In 1st stage operation, chin flap carried half-length of lower lip which designed along previous surgical scar of lip-split mandibular swing approach was flipped into the fistula space for tamponade and residual chin was primarily closed. In 2nd stage operation, partial lip which carried by previous chin flap was flipped back to restore lip length. In 2-year-follow-up, there was no recurrence of OCF with acceptable lip contouring.
Case 2: We presented a 62-year-old man who had tongue cancer underwent total glossectomy and left anterolateral thigh flap reconstruction through lip-split mandibular swing approach developed submental OCF with inlet from moth floor to outlet over submental region on POD13. Lip flap which designed along previous surgical scar of lip-split mandibular swing approach was flipped into the fistula space for tamponade and residual chin was primarily closed. Sacrifice of lower lip length about 1.5cm was noted. In 3-month-follow-up, there was no recurrence of OCF with acceptable mouth opening.
Conclusion:
Given this care report, we believe that utilizing lip or chin flap along with previous scar of lip-split mandibular swing approach to manage OCF over lower face central region. It is a simple and dependable surgical option with affordable sacrifice to manage OCF over lower face central region to prevent delay of adjuvant treatment.

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