# Availability of Primary Closure for Resection of Oral Cavity Cancer
## 4 Discussion  
Malignant lesions in the oral and maxillofacial areas can lead to functional and aesthetic issues after surgical removals, such as impaired mastication and pronunciation [7; 8; 9]. In order to address these defects, various types of flaps are used for reconstruction, including free grafts, local flaps, remote flaps, and free flaps by microvascular anastomosis [10; 11]. In this study, the anterolateral thigh free flap, deep circumflex iliac artery flap, and radial forearm flap were used to recover the defects. Although flap reconstruction provides a basis for implants and restores continuity, it can result in problems such as the loss of essential soft tissue for chewing function [12]. In particular, tongue reconstruction may lead to a decrease in normal tongue mobility [13]. Using flaps to recover the functional defect in the oral and maxillofacial area, but in [PERSON]'s study comparing flaps and primary closure in patients with localized tongue removal of 30% and base 60%, the use of flaps did not show a significant difference in swallow efficiency [14]. In fact, it was confirmed that the swallowing efficiency was higher in the case of the patient who had primary closure than the patient with using the flap. Further, when comparing tongue movements to evaluate pronunciation function, there was no significant difference, but it was confirmed that the case with the primary closure scored higher than the case with the flap [14]. In the study of [PERSON] and [PERSON], when lesions exceeding 30% to 40% were removed, flap restoration was beneficial for functional recovery, but when lesions within the range of 20 to 30% or less were removed, it was confirmed that the use of primary closure did not have a significant difference in functional recovery [15; 16; 17]. In addition, the loss of chewing function was confirmed in [PERSON]'s study that it occurred in extensive resection of the mouth or anterior region or retromolar trigone, and did not occur in any size of tongue resection [18; 19]. In this study, primary closure was performed in patients in the early stage, Stages I and II, and in the lesions of squamous cell carcinoma, mucoepidermoid carcinoma, and verrucous carcinoma. A statistically significant correlation was confirmed between stage  
Figure 3: A 55-year-old Female/Left floor of mouth was diagnosed with SCC. The patient underwent a wide resection followed by primary closure using buccinator muscle: (**a**) Preoperative photo; (**b**) Primary closure with buccinator muscle flap; (**c**) one month after operation. and primary closure (\(p<0.05\)). This means that primary closure may be useful after the removal of early-stage (stage I or II) malignant lesions. The lesions occur on the tongue, gingiva, and buccal mucosa and can be closed with adjacent soft tissue. Figure 2 is a patient who was followed up after resection under the diagnosis of squamous cell carcinoma on the left lateral border of the tongue. Primary closure was performed with remained the tongue and mucosa of the floor of the mouth. Figure 3 is a patient who was followed up after resection under the diagnosis of squamous cell carcinoma on the left floor or mouth. Primary closure was performed with mucosa on the floor of the mouth and buccinator muscle flap. Even when only patients with Stages I and II were compared, the operation time and hospitalization period were statistically significantly shorter in patients who underwent primary closure. In addition, the analysis of variance results showed that the reconstruction method had a statistically significant effect on the operation time and hospitalization period. In the follow-up observation of 16 patients who had been treated for the defect with the primary closure, the patients did not complain of discomfort, but at the initial follow-up of the outpatient clinic after discharge, 5 patients complained of a feeling of pulling at the operation site. Patients complaining of abnormal pronunciation in functional aspects were also observed.