# The Trans-facial Approach for Simultaneous Resection and Reconstruction of Retromolar Trigone Tumors: A Pilot Study

## TL;DR

A new surgical method called the trans-facial approach is introduced to treat small tumors in a hard-to-reach mouth area, avoiding major surgery and offering good recovery.

## Contribution

The trans-facial approach enables simultaneous resection and reconstruction of small RMT tumors without requiring a cheek flap.

## Key findings

- Six out of eight patients successfully underwent resection and reconstruction using the trans-facial approach with no major complications.
- 50% of patients had pT1 tumors and 75% had pN0 status, indicating favorable oncologic outcomes.
- All patients had locoregionally controlled status after a median follow-up of 18 months.

## Abstract

Early retromolar trigone (RMT) lesions are difficult to access and free tissue transfer is often an overkill for such small lesions. The aim was to devise a novel surgical approach that would aid the resection without raising a cheek flap and simultaneously provide a local reconstructive option for small lesions in the RMT.

This study was to demonstrate the outcomes of the “trans-facial” approach used to simultaneously access and reconstruct small RMT tumors through an islanded nasolabial flap. Patients with histologically proven squamous cell carcinoma of RMT requiring surgery were included from January 2021 to September 2022. Case selection was done based on the location of the disease and its size (cT1/T2). All needed bone and soft tissue resection via per oral trans-facial approach, along with an ipsilateral neck dissection. The technique is described along with their post-operative and pathologic outcomes.

Out of the eight patients included in this study, six underwent a bi-alveolar marginal resection and reconstructed using the trans-facial approach. No major complications were noted in the post-operative period. 50% were pT1 tumors and 75% were pN0 status. One patient had a close margin; while, the others had adequate resection margins. All patients were followed up for a median of 18 months with a locoregionally controlled status.

The trans-facial approach can be a suitable option with a reasonable oncologic outcome to address small RMT lesions.