NOTICE Undefined index: accesoInstituciones (includes_ws_v2/librerias/utilidades.php[1006])
Intraoral paratrichosis after autograft | Cirugía y Cirujanos (English Edition)
Buscar en
Cirugía y Cirujanos (English Edition)
Toda la web
Inicio Cirugía y Cirujanos (English Edition) Intraoral paratrichosis after autograft
Journal Information
Vol. 83. Issue 4.
Pages 309-311 (July - August 2015)
Visits
1734
Vol. 83. Issue 4.
Pages 309-311 (July - August 2015)
Clinical case
DOI: 10.1016/j.circen.2015.09.009
Open Access
Intraoral paratrichosis after autograft
Paratricosis en cavidad oral tras autoinjerto
Visits
...
Juan José Segura-Sampedroa,e,
Corresponding author
segusamjj@gmail.com

Corresponding author at: Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41012 Sevilla, Spain. Tel.: +34 6370 28024.
, Consuelo Sampedro-Abascalb, Loreto Parra-Lópezc, Juan Carlos Muñoz-Rodríguezd
a Unidad de Gestión Clínica de Cirugía General y del Aparato Digestivo, Hospital Virgen del Rocío, Sevilla, Spain
b Centro de Salud Mercedes Navarro, Unidad Docente de Medicina Familiar y Comunitaria, Sevilla, Spain
c Unidad de Gestión Clínica de Uronefrología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
d Centro de Salud Alcalde Manuel Bustos, Mairena de Alcor, Sevilla, Spain
e Unidad de Cirugía General y del Aparato Digestivo, Hospital Universitario Son Espases, Palma de Mallorca, Spain
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Abstract
Background

Radial graft is one of the optimal treatments for reconstruction after tongue cancer, but it is not free of side effects. Hypertrichosis over the graft, causing an intraoral paratrichosis, might downgrade the quality of life and even require further interventions.

Clinical case

The case is presented of a 58 year-old man, who developed hypertrichosis after surgery for tongue carcinoma.

Discussion

The therapeutic options, from choosing a graft from less hairy areas to laser depilation or de-epithelisation of the graft are discussed.

Conclusions

Intraoral paratrichosis is a serious complication that can produce dysphagia, nauseas, and vomiting, and can evolve into mal nutrition and produce an important decrease in life quality of patients.

Keywords:
Graft
Flap
Hair
Hypertrichosis
Paratrichosis
Intraoral
Tongue
Reconstruction
Resumen
Antecedentes

El injerto radial es uno de los tratamientos de elección para la reconstrucción tras el cáncer de lengua, pero no está libre de problemas posteriores. La hipertricosis sobre el injerto provocó una paratricosis intraoral que puede disminuir la calidad de vida del sujeto, y hacer que requiera nuevas reintervenciones.

Caso clínico

Presentamos el caso de un varón de 58 años que tras cirugía por carcinoma de la base de la lengua presenta paratricosis sobre el injerto radial.

Discusión

Se discuten las distintas opciones terapéuticas que abarcan desde la elección de colgajos procedentes de regiones anatómicas con menor densidad capilar, hasta el uso de técnicas de depilación láser o la desepitelización del colgajo.

Conclusiones

La paratricosis intraoral es una complicación importante que puede condicionar disfagia, náuseas y vómitos, con la subsecuente desnutrición que disminuye considerablemente la calidad de vida del paciente.

Palabras clave:
Colgajo
Injerto
Pelo
Hipertricosis
Paratricosis
Intraoral
Lengua
Reconstrucción
Full Text
Background

Reconstructive surgery after intraoral neoplasias is a true challenge for a surgeon. Radial graft is one of the optimal treatments, but it is not free of side effects. In the case we present here, a hypertrichosis over the graft, causing an intraoral paratrichosis, might downgrade the quality of life and even require further interventions.

Clinical case

The patient is a 58-year-old man with a personal history of alcoholism and smoker of 40 cigars daily for around 35 years. He came for a consultation because of a 3-day evolution odynophagy and dysphonia. During exploration, he presented hyperaemic oropharynx with right submaxilar adenopathy of around 3cm diameter, unpainful, hard and undisplaceable. Due to clinical persistence, despite the treatment, he was referred to the service of Otolaryngology, which undertook a biopsy of the adenopathy, the result showing epidermoid tongue carcinoma T3N1Mx.

After this diagnosis, surgical treatment was performed with extirpation, functional cervical dissection and reconstruction with microvascularized radial flap, with no radiotherapy.

The patient was on a diet prescribed by a nutritionist, gave up his toxic habits and followed symptomatic treatment of mucositis.

A good functional recovery was achieved in speech and swallowing; tongue sensitivity was recovered at 6 months. As a consequence, paratrichosis was left on the flap, which affected the quality of life of the patient (Fig. 1). To palliate this problem, he was shaved, since he showed dysphagia to solid and liquid intake.

Figure 1.

Intraoral paratrichosis over radial graft.

(0.14MB).

The persistence of previous clinical data led to laser treatment. Good results were obtained and the patient manifests minimal discomfort and can perform the different oro-buccal functions without inconvenience.

Discussion

During surgery of the oral cavity carcinoma, tongue reconstruction is the key factor for functional recovery. In the oral cavity, it is particularly important that the reconstruction method keeps the 3 main functions: speech, mastication and deglutition. One of the most used reconstructive techniques is the radial free flap.1

Intraoral paratrichosis is described as a relatively common complication after these techniques, even though the numbers are very small; Chaine et al.2 described only one case among 25.

This complication does not only cause discomfort and decrease the patient's quality of life, but also sometimes causes nausea and vomiting, directly affecting the nutritional state. The natural evolution of this complication is the decrease of capillary growth over time; however, when this does not occur, laser depilation is the correct thing to do. The use of different sources of energy was described in the literature.3,4 A last resort is the option to perform a de-epithelisation of the flap2 to avoid this complication. The group Sieg et al.5 recommend the use of flap of the forearm's ulnar region, since this is usually a less hairy area.

Conclusion

Intraoral paratrichosis is a relatively common complication that should not be neglected in reconstructive buccal surgery. It is not only an aesthetic problem but also causes great discomfort, deterioration of the quality of life, and can influence deglutition and malnutrition problems. The treatment of this ailment includes the use of grafts with lower capillary density, such as the forearm's ulnar region, up to laser treatment or even reintervention to de-epithelialise the flap.

Conflict of interest

The authors declare that there are no conflicts of interest.

References
[1]
M. Acosta Feria, P. Infante Cossío, A. García-Perla García, E. Torres Carranza, R. Belmonte Caro, J.L. Gutiérrez Pérez.
Colgajo libre radial de doble paleta cutánea para reconstrucción de lengua y suelo de boca.
Rev Esp Cir Oral Maxilofac, 28 (2006), pp. 287-294
[2]
A. Chaine, P. Pitak-Arnnop, M. Hivelin, K. Dhanuthai, J.C. Bertrand, C. Bertolus.
Postoperative complications of fibular free flaps in mandibular reconstruction: an analysis of 25 consecutive cases.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 108 (2009), pp. 488-495
[3]
F.J. Conroy, P.J. Mahaffey.
Intraoral flap depilation using the long-pulsed alexandrite laser.
J Plast Reconstr Aesthet Surg, 62 (2009), pp. e421-e423
[4]
C. Lumley.
Intraoral hair removal on skin graft using Nd:YAG laser.
Br Dent J, 203 (2007), pp. 141-142
[5]
P. Sieg, J.O. Zieron, S. Bierwolf, S.G. Hakim.
Defect-related variations in mandibular reconstruction using fibula grafts. A review of 96 cases.
Br J Oral Maxillofac Surg, 40 (2002), pp. 322-329

Please cite this article as: Segura-Sampedro JJ, Sampedro-Abascal C, Parra-López L, Muñoz-Rodríguez JC. Paratricosis en cavidad oral tras autoinjerto. Cir Cir. 2015;83:309–311.

Copyright © 2015. Academia Mexicana de Cirugía A.C.
Article options
Tools
es en pt
Política de cookies Cookies policy Política de cookies
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.