Buccal Mucosa Cancer Surgery, OSMF release & Reconstruction.

Oral Submucous Fibrosis (OSMF) is a chronic, progressive, scarring disease of the oral cavity, primarily caused by chewing betel nut (areca nut) and gutkha. The alkaloids in betel nut trigger excessive collagen production, turning the normally soft cheek lining stiff, fibrous, and white. OSMF is classified as a potentially malignant disorder (PMD). Over time, the chronic inflammatory microenvironment can undergo genetic changes leading to squamous cell carcinoma in approximately 7-10% of cases.

In cases where buccal mucosa cancer is associated with severe trismus due to OSMF, the surgical resection of the tumor is combined with a fibrous band release (fibrotomy). The stiff fibrous tissue is cut to mobilize the jaw. To prevent the jaws from scarring down and locking shut again postoperatively, it is crucial to reconstruct the cheek lining using thin, healthy tissue, such as a microvascular radial forearm free flap. Active postoperative jaw exercise protocols are initiated early to maintain the mouth opening.

Buccal mucosa cancer requires partial or segmental bone removal (mandibulectomy or maxillectomy) when the tumor grows deep enough to invade the periosteum (the outer membrane covering the bone) or directly infiltrate the jaw bone itself. Dr. Saha utilizes preoperative contrast CT or MRI scans to check for bone erosion. If bone involvement is confirmed, removing the affected segment of bone is necessary to ensure clear tumor-free boundaries (R0 margins). The resected bone is then reconstructed, often using a vascularized fibula free flap to restore jaw function and shape.

No. Performing a biopsy on a suspicious lesion inside the cheek does not cause the cancer cells to metastasize or spread. A biopsy is the mandatory diagnostic procedure to establish a histological confirmation of cancer, determine the tumor grade, and plan the surgical margins. Avoiding or delaying a biopsy due to fears of spread allows the cancer to invade deep muscle and bone, significantly worsening the prognosis.