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Re: Reconstruction of the maxilla by submental flapWe read with interest the article by Rahpeyma and Khajehahmadi, entitled 'Reconstruction of the maxilla by submental flap 1 ', especially at a time when there appears to be a resurgence in the use of regional flaps for head and neck reconstruction. 2 Firstly, we ask for clarification. We note that the authors compared their fistula rate of 20% to a quoted 7.5% rate for reconstruction with free microvascular flap reconstruction. The reference given is for Hanasono's paper; 3 however, we were unable to find the quoted 7.5% fistula rate, but instead find early and late oroantral fistula rates of 0.4% and 2.5%, respectively.Secondly, there is an ongoing debate about the safety of the submental flap in head and neck cancer, and having acknowledged Martin in their paper, we would like to draw their attention to the recent paper by Fell et al., with Martin as senior author, which cautions the use of the submental flap as the primary reconstructive choice in head and neck cancer due to the number of nodal fields at risk of metastasis that are violated in the raising and transposition of the flap and the unknown risk on disease control. 4 This point has been widely debated in the literature, particularly in the absence of level 1 nodal disease 5 and we are curious whether this point was taken into consideration and if the submental flap was chosen in part due to benefits of shorter operating time or lack of alternative donor sites, in comparison with workhorse techniques such as the radial forearm free flap.