# Availability of Primary Closure for Resection of Oral Cavity Cancer
## 1 Introduction  
Despite advances in surgical techniques and adjuvant therapies, surgical resection and adequate reconstruction of malignant lesions continue to pose challenges for surgeons. Malignant lesions may initially be asymptomatic, but as they grow larger or develop into ulcers, patients begin to experience pain and other symptoms. In order to prevent a recurrence, an appropriate safety margin must be established, which often results in larger resection sites. Consequently, factors such as the location, type of lesion, and duration of the condition can influence a patient's prognosis [1].  
Malignant lesions in the oral and maxillofacial region can occur in various locations, including the lips, tongue, floor of the mouth, buccal cheek mucosa, upper and lower gingiva, palate, and salivary glands. As a result, surgical modalities and defects vary accordingto the primary cancer site. The oral and maxillofacial area is not only essential for aesthetics but also plays functional roles in swallowing and speech. Therefore, reconstruction and restoration following the removal of malignant lesions in this region must consider not only morphological aspects but also overall functionality [2].  
Reconstruction options following lesion removal include primary closure, free graft, local flap, remote flap, and free flap with microvascular anastomosis. For extensive malignant lesions, a combination of free grafts, local flaps, remote flaps, and free flaps with microvascular anastomosis may be used to achieve both morphological and functional restoration, depending on the components involved [3]. However, for localized malignant lesions or areas where reconstruction is challenging, primary closure may be the preferred method due to the limited receiving area for flap-based reconstruction. Primary closure involves simply approximating the edges of the wound [4] and is typically performed after resecting small lesions that do not compromise the anatomical structure's movement and function [5].  
In cases where malignant lesions have spread to hard tissues such as alveolar bone and require resection of the hard tissue, flap surgery can reconstruct both the lost hard tissue and the surrounding soft tissue, potentially restoring masticatory function. However, it is true that reconstruction using flaps in defects of soft tissues and muscles, such as the tongue and pharynx, may recover the lost volume but has limitations in restoring the inherent abilities of soft tissues and muscles, such as swallowing and pronunciation. In these cases, primary closure can be a useful alternative. However, surgeons aiming to remove lesions and reconstruct the area may be so accustomed to finding an appropriate flap depending on the size of the removed lesion, the type of tissue defect, and the functions that need to be restored that they may occasionally forget the alternative option of primary closure.  
This study aims to retrospectively analyze the data of patients who underwent surgery for oral cancer at Chosun University Dental Hospital over the past 10 years, focusing specifically on the characteristics of patients who underwent primary closure. We seek to explore which patients may benefit from primary closure as a useful alternative.