Oral and Maxillofacial Surgery

Abstract Background The aim of this study was to evaluate the effects of multi-walled carbon nanotubes/hydroxyapatite (MWCNT/HA) granules with or without leukocyte- and platelet-rich fibrin (L-PRF) on bone regeneration in cancellous bone of sheep model. Methods Totally, 32 cylindrical holes were drilled in female sheep (n = 4) in the distal epiphysis and proximal metaphysis of right and left humerus and femur. The defects were randomly filled with (1) MWCNT/HA, (2) MWCNT/HA mixed with L-PRF, (3) L-PRF, and (4) left empty as control. After 8 weeks, defects were evaluated and compared radiographically using multi-slice computed tomographic (CT) scan and cone beam CT scans, histologically and histomorphometrically. Results The results showed that there was no significant inflammation (> 10%) or foreign body reaction around the granules. The new lamellar bone was regenerated around the MWCNT/HA nanocomposite granules. Addition of L-PRF to MWCNT/HA demonstrated significantly improvement of new bone formation, about 27.40 ± 1.08%, in comparison with the L-PRF alone, about (12.16 ± 1.46%) (P < 0.01). Also, the rate of new bone formation was significantly greater with the use of MWCNT/HA granules (24.59 ± 1.54%) compared to the control (10.36 ± 1.17%) (P < 0.01). Conclusion Consequently, both biocompatibility and osteoconductivity of MWCNT/HA nanocomposite were demonstrated in the preclinical sheep model, and the use of L-PRF in combination with MWCNT/HA nanocomposite can improve bone regeneration.

Abstract Background In early stage buccal mucosa carcinoma, in spite of successful curative surgery, the health-related quality-of-life (HRQoL) may not improve. We aimed to study HRQoL in these patients who had undergone successful curative surgery and determined factors that influence the HRQoL. Methods Subjects, aged 18–70 years, who had undergone successful curative surgery for stage I and II buccal mucosa cancer, were assessed for HRQoL using the University of Washington Quality of Life Questionnaire and factors affecting HRQoL were determined. Their scores were compared with normative reference scores. Results 54 patients (stages I 54%, II 46%) aged 44 ± 11 years (87% males) were studied. They had undergone curative surgery a median of 8.5 (IQR 4–13.5) months ago. Their mean global HRQoL score was 77 ± 30, with significantly poorer scores compared to reference in domains of appearance, activity, swallowing, chewing, speech, shoulder, saliva, mood and anxiety. Anxiety, activity, and chewing were considered the most important domains by the patients. Among the factors influencing HRQoL, duration since surgery was the most important factor, and patients with recent surgery had worse performance in chewing, saliva and mood. Patients with stage II had worse performance in shoulder and anxiety compared to stage I. Post-operative radiotherapy worsened swallowing and shoulder function. Conclusion In spite of successful curative surgery for buccal mucosa carcinoma, the HRQoL continues to remain sub-optimal with poor scores in most of the domains. These domains must be focused on with appropriate measures in order to improve overall HRQoL in patients after successful curative surgery.

Abstract Purpose Carotid cavernous fistulas (CCFs) are abnormal connections between the cavernous sinus (CS) and carotid arteries. In direct CCFs, a transarterial route is often the preferred vascular access; in case of indirect CCFs, the complex anatomy of the feeder vessels and their extra-intracranial anastomosis makes the transarterial embolization challenging and often ineffective. The aim of this study was to review our experience with the transorbital approach to treat patients affected by CCF who have already experienced an endovascular failure procedure, in order to assess this salvage technique feasibility, by analyzing possible risks and complications. Methods We performed a retrospective study of all patients affected by CCFs who underwent transorbital embolization between February 2017 and February 2019 at our institution. Results All patients (3 cases) tolerated both the retrograde embolization and the direct surgical approach with clinical improvement; the closure of the fistula was complete and verified intraoperatively by angiography. Esthetic result was acceptable in all cases with reduction of the proptosis and the intraocular pressure, and increased visual acuity. There were no complications or clinical recurrence. Conclusion Transorbital approach for the endovascular treatment of CCFs is a feasible and safe salvage procedure, which can find indication after other endovascular access failures.

Abstract Objective There are inconclusive data connecting single-nucleotide polymorphisms (SNPs) of TNF-α (rs361525) and TNF-β (rs909253) to potential malignant oral disorder (PMOD) such as lichen planus and oral fibrosis. Here, we have investigated the risk of oral squamous cell carcinoma as well as oral pre-cancerous lesions in North Indian population with the polymorphism of the TNFα/ β genes. Material and methods A total 500 patients with oral pre-cancer and OSCC and 500 healthy volunteers were genotypes for the TNF-α (-238) G/A (rs361525) and TNF-β (252) A/G (rs909253) gene polymorphism. Genotypes were identified by polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP). Genotype frequencies were evaluated by Chi-square test. Results Compared to the GG genotype, the GA genotype of TNF-α (G238A) polymorphism (rs361525) has been found to significantly increase the risk of oral disease (OR = 1.99) and especially the risk of lichen planus and OSCC (OR = 2.805 and 5.790, respectively). Similarly, the risk of oral disease was also more in the heterozygote (AG) than the common allele homozygote (AA) of TNF-β (A252G) polymorphism (rs909253) (OR = 1.483). Conclusion We conclude that the SNPs rs361525 and rs909253 were significantly associated with oral pre-cancer and OSCC.

Abstract Purpose Peri-implantitis is a biofilm-induced pathological condition, and different approaches have been proposed to manage this condition. This study introduces a surgical technique in accordance with the concept of guided bone regeneration for implants with extensive peri-implant defects. Methods This pilot study was conducted on 7 patients with 11 implants (4 females and 3 males; 32 to 61 years). In this technique, we used a titanium mesh, a combination of autogenous bone, allogenic graft material, and acellular dermal matrix to reconstruct the peri-implant defects. All implants were placed submerged, and the second-stage surgery was conducted after 8 months. Soft tissue augmentation and vestibuloplasty were performed in the second-stage surgery, if required. Results The mean function time of implants was 60.5 ± 29.4 months. The mean baseline probing pocket depth was 5.7 ± 1.4 mm, and soft tissue recession was observed at two sites (18%). The mean recession and keratinized tissue width (KTW) values were 0.4 ± 0.8 mm and 3 ± 1.6 mm, respectively. The mean marginal bone loss and bone gain were 4.4 ± 1.2 mm and 2.9 ± 0.9 mm, respectively, which showed a significant improvement. Conclusion Our preliminary evaluations showed favorable results in terms of radiographic defect fill and soft tissue condition. It appears that this technique may lead to promising outcomes in cautiously selected patients seeking to retain their failing implants. However, long-term results following functional loading are required before recommending this technique for daily practice.

Abstract Objective To evaluate whether periapical surgery affects oral health-related quality of life (OHRQoL) within the first postoperative week. Study design The primary outcomes in 133 patients (54 men, 79 women; mean age 50.8 years) undergoing periapical surgery were the Oral Health Impact Profile-14 (OHIP-14) score and postoperative sequelae, including pain, analgesic intake, swelling, limited mouth opening, chewing difficulties, and postoperative infection. Results We found a significant effect on OHIP-14, pain, and analgesics, which decreased throughout the week. We found no significant differences in mean OHIP-14, pain scores, or analgesic use for gender, medical history, surgical flaps, operation time, or location of the operated teeth. Younger patients had a higher OHIP-14 score in the first 2 days after surgery and more pain on the first postoperative day. Women experienced more pain during the first 3 days. Smokers had a higher OHIP-14 score on the first postoperative day and greater pain during the first 3 days compared to non-smokers. Conclusion We identified a low incidence of pain and reduced OHRQoL following periapical surgery. The postoperative reduction in OHRQoL and pain were of short duration, with maximum intensity in the early postoperative period and rapidly decreasing with time.

Abstract Purpose This study aimed to compare the three-dimensional volumetric changes of human maxillary sinuses after reconstruction using 5 different bone grafts. Patients and methods Patients underwent unilateral maxillary sinus bone height reconstruction using 5 bone substitutes allocated in different groups as follows: group 1 was grafted with autogenous bone graft alone; group 2 with beta-tricalcium phosphate (β-TCP); group 3 with β-TCP + autogenous bone graft 1:1; group 4 with bioactive glass; and group 5 with bioactive glass + autogenous bone graft 1:1. The patients were submitted to cone beam computed tomography in two periods: 15 days after the surgical procedure (T1) and after 6 months (T2). The results were evaluated as the formula T2-T1 expressing the three-volumetric changes of the biomaterials in elapsed time. Results The resorption rate of autogenous bone graft was −630.699 ± 300.9 mm3; in the β-TCP group, it was −315.772 ± 125.6 mm3; in the group with β-TCP + autogenous bone graft 1:1, it was −336.205 ± 195.7 mm3; and in groups with bioactive glass and with the addition of autogenous bone graft 1:1, it was −428.878 ± 311.6 mm3 and −576.917 ± 471.6 mm3, respectively, without statistical difference (p = 0.167). Pearson’s correlated test revealed a strong correlation as well as a progressive resorption of the grafts during bone healing. Conclusion The similar outcomes for the three-dimensional volumetric changes using the bone substitutes evaluated after 6 months of bone healing suggest that all these grafts can be performed to maxillary sinus reconstruction.

Abstract Purpose To compare the intraoperative utility of bur and saw and to examine the pattern of lingual split during bilateral sagittal split osteotomy of mandible. Material and methods This study prospectively compares the intraoperative utility of bur and saw in bilateral sagittal split osteotomy as split-mouth model. Study includes 16 patients (representing 32 sagittal split osteotomies) divided into two groups. The procedure to be performed was explained to the patient, followed by written informed consent. The institutional ethical committee approved the clinical study and all subjects gave informed consent. Results We found that the ease of handling of the bur was good compared to saw. The duration required for completion of osteotomy using bur was less compared to saw. Conclusions The use of surgical drills and burs is still the gold standard in most developing nations and countries in transition like India. Depending upon the expertise of the surgeon, availability of precise dissecting instruments, one can go with either of the instrument for BSSO.

Abstract Purpose Different levels of miRNA expression have been described in salivary gland tumors as a potential diagnostic marker and predictor of survival. We systematically reviewed the literature to assess the diagnostic and prognostic value of miRNAs on salivary gland tumors. Methods An electronic search was conducted in PubMed, Scopus, Embase, Cochrane, and Web of Science databases. In the meta-analysis, we assumed random-effects model with adjusted hazard ratio (HR) and 95% confidence intervals (95% CI). For prognostic studies, the risk of bias was assessed by Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) and Quality Assessment Tool for Diagnostic Accuracy Studies-2 (QUADAS-2) was utilized for diagnostic studies. Results Gathered data from 1.131 patients in seven studies demonstrated that different levels of miRNA expression presented diagnostic and prognostic in SGTs. The meta-analysis showed that altered miRNA expression were associated with shortened survival (HR, 2.35, 95% CI, 1.77–3.10, P < .00001). For diagnostic meta-analysis, the overall pooled results for specificity and sensibility were 0.87–0.97 (95% CI, 0.72–1) and 0.68–0.91 (95% CI, 0.51–0.96), respectively. Conclusion MicroRNAs may be useful in prognostication of patients with SGTs; however, the diagnostic value of miRNAs in SGTs is still limited.

Abstract Purpose A post-operative cooling method in oral and maxillofacial surgery is the cooling with hilotherapy. The aim of this study was the post-operative comparison of cooling temperatures of 18°C and 22°C. The parameters of this trial were swelling and the post-operative pain levels. Methods This study included 156 patients, divided into two groups among whom a mono-one, bignathic osteotomy or genioplasty was indicated. The post-operative assessment of swelling was performed using a 3D optical scanner. This examination was repeated on post-operative days 1, 2, 3, 7, 14, 30, and 90. The examination on day 90 served as a reference value in respect of swelling and pain. Results Group 1 (18°C, 78 patients) showed an increase in post-operative swelling on the 1st post-OP day of 52.06 ± 35.41ml. The maximum was reached on the 2nd post-OP day with 75.82 ± 38.97ml. On the 30th post-OP day, residual swelling measured 11.60 ± 12.62ml. Group 2 (22 °C, 78 patients) showed an increase in postoperative swelling on the 1st post-OP day of 76.07 ± 63.15ml. The maximum was reached on the 2nd post-OP day with 106.97 ± 69.63 ml. On the 30th post-OP day, residual swelling measured 14.36 ± 32.26ml. The differences between the two groups and between different visits were statistically significant. Conclusion The study results indicate less residual swelling in group 1 on the 30th post-OP day, possible based on the lower cooling temperature. The post-operative pain exhibits a comparable level of pain intensity between the two groups. In overall terms, a subjectively more agreeable treatment was observed in group 1.

Abstract Objective To evaluate histologically the early healing at implants installed with different insertion torques Material and methods Three months after the extraction of the mandibular premolars and of the first molars, two implants were installed monolaterally in the premolar and two in the molar regions of the edentulous alveolar ridge of twelve dogs. The recipient sites were prepared using drills of different diameter to obtain insertion torque of different values, i.e., 30 Ncm (control) or ~ 70 Ncm (test) in the premolar region, and < 10 Ncm (test) or ~ 50 Ncm (control) in the molar region. Six animals were euthanized after 4 weeks and six after 8 weeks of healing. Histological analyses were performed, and the Wilcoxon test was applied for statistical analyses. Results After 4 weeks of healing, in the premolar region, the new bone in contact with the implant surface was 65.0 ± 4.6% and 53.9 ± 13.5% at the ~ 30-Ncm and ~ 70-Ncm sites, respectively (p = 0.075). In the premolar region, new bone proportions were 51.4 ± 17.0% and 67.3 ± 7.0% at the < 10-Ncm and ~ 50-Ncm sites, respectively (p = 0.046). After 8 weeks of healing, in the premolar region, new bone reached fractions of 77.7 ± 16.2% at the ~ 30-Ncm sites, and 68.3 ± 12.1% at the ~ 70-Ncm sites (p = 0.028). In the molar region, new bone presented proportions of 70.2 ± 6.4% at the < 10-Ncm sites and 76.2 ± 9.4% at the ~ 50-Ncm sites (p = 0.173). Conclusions The insertion torque influenced the osseointegration of implants. Higher values of bone-to-implant contact percentages were registered for insertion torques of ~ 30 Ncm and ~ 50 Ncm. Implants inserted with torque < 10 Ncm became integrated with an optimal osseointegration.

Abstract Purpose The aim of the present study was to evaluate the four methods for bilateral sagittal osteotomy fixation. Methods In this study, 56 replicas of whole mandibles made of rigid polyurethane were used. After simulation of major advancement (11 mm) with clockwise rotation of the mandible (6o) in relation to the occlusal plane, the bone segments were fixed with plates and screws of the 2.0-mm system on both the right and left sides: group I, double “H” plate; group II, two mini-plates; group III, “hybrid technique”; and group IV, three bicortical screws in the “inverted L” pattern. The mandibles were submitted to load on the central incisors and right first molar. Results The mean value of group I was higher than those of groups IV and II in the displacement of 1 mm (F = 4.705; p = 0.010) with load on the incisor. The mean value of group III was higher than those of groups I and II in the displacement of 1 mm (F = 5.166; p = 0.007) and 3 mm (F = 5.166; p = 0.007). The mean value of group IV was higher than that of group II (F = 3.142; p = 0.044) with load on the molar. Conclusion Therefore, after the analyses, the hybrid technique was the one that showed the best results.

Abstract Purpose To assess the analgesia and side effects of codeine phosphate associated with paracetamol (test medication) as compared to paracetamol (control medication) after the extraction of impacted mandibular third molars. Materials and methods Forty-seven patients removed the right and left impacted mandibular third molars. After one surgery, patients took the test medication and after the other surgery, they took the control medication. Patients with exacerbated pain were prescribed to use the rescue medication instead of the medication initially administered and were included in the rescue group. They were evaluated for 7 days postoperatively, and the mean score of the visual analogue scale (VAS) of pain between test and control medications was assessed by the Poisson distribution. The side effects of these medications were assessed by the patient’s complaints. A P value of < .05 was considered to be statistically significant. Results The mean score of the VAS of pain was not statistically different between test and control medications in the non-rescue group, but it was significantly greater in patients previously using paracetamol in the rescue group. The most common side effects reported in both groups, predominantly in patients using the test medication, were drowsiness, dizziness, and nausea. Conclusion The use of codeine phosphate associated with paracetamol after the extraction of impacted mandibular third molars is a better choice to control the postoperative pain rather than paracetamol, but with more side effects, which are clinically acceptable.

Abstract Background Harmonic instruments are becoming popular in head and neck surgeries. In this prospective, randomized study, the efficacy of the harmonic instruments and electrosurgical technique is compared. Materials and methods A total of 48 patients undergoing unilateral neck dissection were divided into two groups. In one group, surgery was performed using conventional hemostatic instruments while in the other, only harmonic instruments were used. The two techniques were then compared with regard to intra- and post-operative blood loss, complications in operating time, drain, tracheotomy and nasogastric tube duration, and post-operative hospital stay. Results Differences in operative time (P = 0.647), total suction drainage (P = 0.362) and time that drains (P = 0.404), nasogastric tube (P = 0.378), and tracheotomy (P = 0.052) were kept in place and proved not significant. The average blood loss during surgery was significantly greater in the CH group (P = 0.003) as the number of hemoclips and resorbable ligature used (P = 0.002). Conclusions In contrast to what has been reported up to now, our study did not reveal a net advantage in the use of harmonic instruments with respect to classical instruments in terms of surgical outcome. On the contrary, harmonic tools had a higher complication rate (i.e., salivary fistula and lymphatic leak) probably due to the decreased ability of this instruments to permanently close glandular structures and lymphatic ducts. In these cases, a closure technique such as electrocautery or classic knot-tying should be used.

Abstract Purpose In maxillary wisdom tooth extraction, the necessity of CT is unknown. The purpose of this study was to investigate whether CT adding to orthopantomography is useful for predicting oroantral perforation during maxillary third molar extraction. Methods Various risk factors for oroantral perforation during maxillary third molar extraction were investigated by univariate and multivariate analyses. We analyzed those of all patients and the patients who underwent CT, respectively. The proximity of the roots to the maxillary sinus floor (root-sinus [RS] classification) and Archer classification were assessed using panoramic radiography. The number of roots and vertical relationship were assessed using CT. Results A total of 604 out of 3299 patients underwent CT adding to orthopantomography. In all cases, multivariate analyses except for CT findings showed that the RS classification type III/IV and the Archer classification Type B/C/D in panoramic findings were significantly correlated with oroantral perforation as radiological findings. In cases for which CT was performed, multivariate analyses showed that one root (OR 12.87) and the vertical relationship Type D (OR 5.63) in CT findings, besides the RS classification type III/IV (OR 4.47) in panoramic findings, were significantly related to oroantral perforation. Conclusion The RS classification and the Archer classification in panoramic findings can predict the risk of oroantral perforation. The usefulness of CT adding to orthopantomography is limited. However, when the relationship between the upper wisdom tooth and maxillary sinus floor (RS classification) is unclear, to check whether the number of roots is one and the apex of one root is projecting into the maxillary sinus in CT findings, is useful for the prediction.

Abstract Introduction The most common complications following superficial parotidectomy are formation of contour deformity and development of Frey’s syndrome. Multiple modalities are being used to prevent these complications. We hereby intend to compare the reconstruction modalities (sternocleidomastoid (SCM) muscle flap, posterior belly of digastric (PBD) muscle flap) with) No reconstruction (NR) following superficial parotidectomy. Materials and methods A comparative study was designed which included 15 patients requiring parotidectomy. These patients were divided into three groups viz. SCM, PBD, and NR. The functional outcome (facial nerve involvement, Frey syndrome, ear lobule sensation, neck movements) and the esthetic results were evaluated subjectively and objectively. The outcomes were statistically evaluated using chi-square test and ANOVA test. Results Facial nerve palsy occurred in 2 cases in each group, and all of them recovered completely within 6 months. The Minor starch iodine test was positive in 1 patient in the SCM group, in 2 patients in the PBD group, and in 4 patients in the NR group; only 1 patient of PBD group and 3 patients of NR group complained of gustatory sweating. Neck movements were unaffected in the PBD and NR groups; however, 1 patient complained of mild discomfort and pain during neck movements in the SCM group. Conclusion Primary closure showed the worst results regarding cosmetic deformity. Hence, it is recommended to mandatorily reconstruct the defect. However, the sternocleidomastoid muscle flap is a better cosmetic option compared with posterior belly of digastric muscle flap. In cases with larger defects, a combination of both the flaps can be used. SCM flap also lowers the incidence of Frey syndrome objectively and subjectively with no reported hazard of the spinal accessory nerve and mildly affected neck movements.

Abstract We report a rare case of lymph node metastasis of papillary thyroid cancer (PTC) incidentally detected in a neck dissection specimen of tongue squamous cell carcinoma (SCC). A 42-year-old Japanese woman was diagnosed with tongue SCC (T1N0M0, Stage I). Partial glossectomy with supraomohyoid neck dissection was performed under general anesthesia, and histopathological examinations revealed primary SCC of the tongue and neck metastasis of PTC in neck dissection specimens. A few months later, total thyroidectomy and left modified radical neck dissection were performed by thyroid surgeons. The histopathological diagnosis was PTC of both the thyroid glands. There was no evidence of tumor recurrence or distant metastasis at the 9-month follow-up.

Abstract Objective To compare osseointegration and marginal bone level at implants placed in osteotomies prepared with either conventional drills or a piezoelectric device. Material and methods Three months after the extraction of all mandibular premolars and first molars, two recipient sites were selected. The osteotomies were randomly prepared with either conventional drills (drill sites) or a piezoelectric device (piezoelectric sites). Implants were installed and a submerged healing was allowed. The animals were euthanized in groups of six after 4 and 8 weeks of healing. Biopsies were obtained for histological preparation. Coronal level of osseointegration (bone level) and bone-to-implant contact percentage (BIC%) were evaluated. Results After 4 weeks of healing, the bone level was 0.6 ± 0.9 mm for the piezoelectric sites and 1.6 ± 0.7 mm for the drill sites (p = 0.173). After 8 weeks, the respective measures were 0.9 ± 0.3 mm and 1.0 ± 1.1 mm (p = 0.917). After 4 weeks of healing, a new bone apposed onto the implant surface was found at fractions of 54.9 ± 6.7% and 55.1 ± 16.6% for the piezoelectric and the drill sites, respectively (p = 0.674). The respective total bone fractions, including new and old bone, was 64.0 ± 4.8% and 63.4 ± 20.4% (p = 0.917). After 8 weeks, a new bone increased to 67.4 ± 6.7% and 62.9 ± 12.5% for the piezoelectric and the drill sites, respectively (p = 0.463). The respective total bone fractions were 70.4 ± 5.5% and 67.8 ± 12.1% (p = 0.753). Conclusions The use of a piezoelectric device for implant site preparation is a safe procedure that allows a proper integration since the early periods of healing similar to that observed using conventional drills.

Abstract Objectives The purpose of this study was to examine changes in lateral pterygoid muscle and temporomandibular joint (TMJ) disc position in classes II and III patients, before and after bi-maxillary surgery. Materials and methods The subjects were comprised of 48 patients (96 sides), 23 of whom were diagnosed as class II and 25 as class III patients who underwent Le Fort I osteotomy and sagittal split ramus osteotomy (SSRO). The cross-sectional measurements of the lateral pterygoid muscles were measured at two levels of horizontal plane images (condyle and mandibular notch levels) by computed tomography (CT), before and 1 year after the operation. The relationship between these measurements regarding lateral pterygoid muscle and disc position by magnetic resonance image (MRI) was also examined statistically. Results Preoperatively, class II was significantly larger than class III in condylar angle at the upper level and in long diameter, square, condylar angle, and muscle angle at the lower level (P < 0.05). After 1 year, class II was significantly larger than class III in condylar angle, long diameter, and muscle angle at the upper level and in long diameter, short diameter, square, condylar angle, and muscle angle at the lower level (P < 0.05). TMJ disc position classification correlated significantly with condylar angle at the upper level and long diameter and condylar angle at the lower level (P < 0.0001). Conclusion This study suggested that there were differences in the cross-sectional measurements of the lateral pterygoid muscles between class II and class III patients, before and after bi-maxillary surgery.

Abstract Introduction Metastatic oral tumours are rare, contributing to 1% of all malignant oral cavity tumours. Case report We report the case of a 59-year-old man with colon cancer at an advanced disease stage, with progression to the peritoneum and maxillary gingiva. Palliative surgery was indicated to improve the patient’s quality of life. Discussion In a review of the literature, we compiled a list of 27 cases (including the present case) reflecting some 30 years of literature on oral cavity metastatic disease originating in colon cancer. Conclusion Oral cavity metastasis should be taken into account in the differential diagnosis of a synchronous or metachronous oral cavity lesion. The therapeutic goal should include palliative alternatives when necessary. Intraoral reconstruction using local flaps may be a simple and reliable palliative resection option aimed at improving the patient’s quality of life.