Buccal mucosa wide local excision

Considerations

• • Indications 

    • Squamous cell carcinoma - Classically described as "aggressive"

    • 2006: Squamous cell carcinoma of the buccal mucosa: an aggressive cancer requiring multimodality treatment

    • Special cases 

      • Mammary analogue secretory carcinoma (MASC)

      • 2015: Mammary analogue secretory carcinoma: Update on a New Diagnosis of Salivary Gland Malignancy

  • Margins 

    • 1 cm gross margins are standard 

    • Pay attention to the deep resection margin

      • The deep margin should contain at least one layer of normal tissue beyond the tumor

        • For superficial lesions, it should contain the buccinator muscle with 

        • For deeper lesions, it should contain the buccal fat pad or the zygomaticus major muscle

        • For even deeper lesions, e.g. adhering to skin or causing peau d’orange, it should contain the overlying skin

  • 2010: Buccal mucosa carcinoma: surgical margin less than 3 mm, not 5 mm, predicts locoregional recurrence

  • Reconstruction 

    • Small defects can be closed primarily, or left to granulate and heal by secondary intention

    • Larger defects that include resection of the buccinator muscle that are left to granulate may lead to significant trismus due to scarring and contraction of the scar tissue

    • Options 

      • Alloderm - .33-.76 mm thickness

      • STSG

        • Be wary of grafting larger flaps since contracture and trismus may result

      • Buccal fat pad flap

      • Tongue flap

      • Nasolabial flap

      • Temporalis flap 

      • Pectoralis major flap 

      • Deltopectoral flap

      • Radial forearm free flap 

Preparation

Procedure

• • a

  • a

  • a

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Sample operative report

Post-op

• • Medications 

  • Diet 

  • Rehabilitation

    • Jaw opening 

      • Given the potential for disabling trismus, begin jaw opening exercises about POD 5-7 and continue for the first 6-12 months

• CPT codes

  • • 40814 - Excision of lesion of mucosa and submucosa, vestibule of mouth; with complex repair

Pearls & Pitfalls

High-Yield

Links

• eMedicine - Buccal Carcinoma

• eMedicine - Buccal Carcinoma Treatment & Management

• OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY - SURGICAL RESECTION OF CANCER OF THE BUCCAL MUCOSA