Buccal mucosa wide local excision
Considerations
Indications
Squamous cell carcinoma - Classically described as "aggressive"
Special cases
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
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
a
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