Facial-submental island flap for reconstruction of hemitongue defects in young, middle-aged and elderly patients with early and middle stage oral tongue squamous cell carcinoma

Abstract

Background This study evaluated the outcomes of facial-submental artery island flap (FSAIF) for reconstruction of the hemitongue following cancer ablation in patients with early and middle-stage oral tongue squamous cell carcinoma (OTSCC). Methods In total, 122 patients with early and middle-stage OTSCC were divided into young, middle-aged, and elderly groups. The Adult Comorbidity Evaluation-27 (ACE-27) index was used to determine the presence of comorbidities. The patients underwent surgical treatment with hemiglossectomy, neck dissection, and hemitongue reconstruction using FSAIF. In addition, stage I (n = 15) and II (n = 69) patients underwent ipsilateral selective neck dissection, whereas those with stage III (n = 38) underwent radical neck dissection. Six patients with T3N1 disease also underwent cobalt-60 adjuvant radiotherapy. Results Young and elderly patients exhibited significant differences in comorbidities, as assessed by the ACE-27 (p < .05). The skin paddles in the young, middle-aged, and elderly patients were 3 × 9 to 4 × 12 cm, 3 × 11 to 4 × 12, and 3 × 10 to 5 × 13 cm in size, respectively. FSAIF failure occurred in four patients (success rate: 96.7%). No significant differences were observed in the skin paddle of the flap or rate of flap failure among the age groups (p > .05). Clavien-Dindo grades I, II, IIIa, IIIb, Iva, and IVb were assigned to 7.1, 36.1, 38.5, 9.8, 4.1, and 4.1% of the patients, respectively, with significant differences seen between the young and elderly patients (p < .05). In total, 52.5% of patients could eat normally, whereas 32.8% required a soft diet. Furthermore, 53.3 and 33.6% of patients achieved normal and intelligible speech, respectively. The aesthetic results were rated as excellent and good in 32.8 and 58.2% of patients, respectively. In total, 68.0% of the patients were alive and exhibited no evidence of disease, while 19.7% were alive with active disease. In addition, 12.3% of patients with stage III OTSCC died due to local recurrence or distant metastases. No differences in swallowing, speech, aesthetic, or survival outcomes were observed among the groups. Conclusions FSAIF is a simple, safe, and reliable method for reconstructing hemitongue defects following cancer ablation in young, middle-aged, and elderly patients with early and middle-stage OTSCC.

Facial-submental artery island flap combined with titanium plate for repairing defects after mandibular marginal resection for stage 3 medication-related osteonecrosis of the mandible in cancer patients

“…The ndings of our study demonstrate the simplicity, safety, and reliability of a FSAIF for reconstructing oral defects in elderly patients. 11,12 In patients with stage 3 MRONM, the exposed necrotic bone extends beyond the lower boundary and mandibular ramus, or osteolysis extends to the lower boundary of the mandible. After complete ablation of the necrotic bone and infected soft tissue, the remaining mandible in the defect area is too thin to bear the bite force; thus, it must be reconstructed with a titanium plate to prevent mandibular fracture.…”

“…Numerous reports by Chen et al suggest that the facial-submental artery island ap (FSAIF) is reliable for the repair of oral and maxillofacial defects. [9][10][11][12] The aim of the present study was to evaluate the outcomes of patients with advanced MRONM in whom FSAIF was combined with a titanium plate to repair exposed bone and soft tissue defects after complete ablation of the necrotic bone, including marginal resection of the mandible and infected soft tissue.…”

Tongue Reconstruction with Buccinator Myomucosal Island Flaps: Technical Considerations, Oncologic Safety, Functional Outcomes and QoL Assessment—A Retrospective Observational Study

“…Several reconstructive techniques have been proposed, including primary closure [ 6 , 7 ] and the use of local, [ 8 , 9 , 10 ] regional [ 9 ] and distant free flaps [ 13 , 14 ]…”

“…Numerous tongue reconstruction techniques are currently available. These methods range from direct closure [ 6 , 7 ], local flaps [ 8 , 9 , 10 ], regional flaps [ 11 , 12 ] to free flaps [ 13 , 14 ], each offering different benefits and challenges. While radial forearm (RF) and anterolateral thigh free flaps (ALT) are currently the gold standard for tongue reconstruction, providing satisfactory functional rehabilitation [ 15 , 16 ], buccinator myomucosal island flaps offer a promising alternative.…”