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The possible methods for plastic reconstruction after resection of malignant tumors in the mouth and oropharynx are reported. A total of 165 patients, operated upon between 1973 and 1980, has been reviewed. The tumor was located 26 times in the tongue, 4 times within the base of the tongue, 27 times in the floor of the mouth, 10 times in the floor of the mouth and in the tongue and 80 times in the tonsils. For reconstruction 8 times the deltopectoral flap, 51 times the forehead flap, 42 times the tongue flap, 7 times the myocutaneous sternocleido-mastoideus island flap were used. 8 times other methods were applied, like for instance skin grafts, and in 41 cases a primary closure of the defect was possible. Complete necrosis of the flap were rare, more frequent in contrast were partial dehiscences with or without a fistula. Thus in the forehead flap 5 times a necrosis occurred whereas in 15 cases a dehiscence was seen. Even better results were achieved for the deltopectoral- and tongue flap. In contrast, the skin island of the myocutaneous sternocleidomastoideus flaps all became necrotic, but only once a temporary fistula developed. Of the pectoralis myocutaneous island flaps the first two became necrotic, probably due to lack of surgical experience. Taking into account the surgical expenditure, the functional as well as cosmetical results, the methods may be scaled according to clinical value as follows: The pectoralis major myocutaneous island flap and the tongue flap equally range on the first place, followed by the myocutaneous sternocleidomastoideus island flap, and on the 3. and 4. place by the deltopectoral and forehead flap.

The covering of defects in ablative oral surgery is associated with particular problems because, in order to avoid the formation of salivary fistulas, a primary closure should be aimed at. Between 1973 and 1975 86 carcinomas of the floor of the mouth, the tongue or the oropharynx were treated by block resection including radical neck dissection without preoperative radiation in 28 Cases the forehead flap and in 20 cases the tongue flap were employed. While the foreheaded flap necessitates the preservation of the ipsilateral A. carotis externa, the tongue flap can be used even if the ipsilateral lingual artery is sacrified. The tongue flap has functional and cosmetic advantages in comparison to the forehead flap. The temporarily transsected mandibula was refixed by compression plates without intermaxillary wiring.

Tumours of the oral cavity and the oropharynx account for 12% of the malignancies in our patient material. The group of patients included a high percentage of smokers (83%), heavy drinkers and persons neglectful of oral hygiene. The majority of the patients mainly male were labourers or (small) farmers. In contrast to other reports in the literature, chronic mechanical trauma due to sharp remaining teeth, less than ideal fillings, badly fitting dentures or unsuitable denture-bearing tissue, and loose anchoring attachments were frequently present. Commensurate with the clinical findings, permanent damage to the covering squamous epithelium was demonstrated histologically. In addition to all forms of inflammation, parakeratosis and hyperkeratosis, dysplasia, including carcinoma in situ, and manifest carcinomas also presented. Surface-inert dentures and regular oral hygiene must therefore be considered an important requirement for the prevention of oral-cavity carcinoma.

The mandibles of 24 patients with a squamous cell carcinoma of the floor of the mouth or the tongue or the tonsils (all were T2N1b and T3N1b), were histologically examined. It could histologically be shown, that the bone will be destroyed by 2 modalities: 1. Atrophy of the mandible, caused by the pressure of the tumor, leaving the periosteum intact 2. Infiltration of the tumor into the bone. Tumor cells could not be found in the lymphatic system of the periosteum. Since the periosteum is a barrier against tumor growth, the indicator for the resection of the mandible was made after shaved off the periosteum. Resulting from our findings we propose the following concept: 1. If the tumor reaches the mandible (distance tumor to bone = 0 mm) or is fixed to the periosteum and the compacta shows no errosion, after shaving off the periosteum, the mandible can be preserved. 2. If the tumor grows through the periosteum, a marginal resection of the mandible is necessary. 3. If the bone shows errosion, a partial resection of the anterior part of the mandible or a hemimandibulectomy is indicated.

The authors present their first experiences gained during the last year with the permanent implantation of 125iodine seeds in thirty patients suffering from carcinomas of the oral cavity and the oropharynx. The properties and advantages of 125iodine, the method of implantation, the dosimetry and the problems of radioprotection are particularly underlined. In every case, we apply pre- or postoperative external radiotherapy, i.e. we expose the primary tumor to a dose of 50 Gy fractionated in the usual manner over four or five weeks. This combined treatment is intended to overcome the resistance to therapy of ORL malignomas and to obtain a high local rate of tumor control and a low rate of functional and cosmetic troubles.

17 out of 22 patients with a squamous cell cancer of the Hypopharynx (T2-T4,N1-N3) are treated by resection of the pharynx and larynx, combined with radical neck-dissection on both sides, total strumectomy and full course of radio-therapy, reaching from the base of the skull down to the madiastinum. For the immediate reconstruction of a nutritional pathway the preservation of a vertical tumor free strip of the pharyngeal wall at least 15 mm broad is recommended. The remaining mucosa resected at least 20 mm from the margin of the tumor, and the edges controlled by frozen sections can be sutured over a nasal gastric tube of 18 or 16 charr. The reconstruction has several advantages. Though the observation time of 15 months is short, the recurrence rate seems not to be higher than after total resection of the pharynx and larynx.