Submental flap for reconstruction of anterior skull base, orbital, and high facial defects

Chang, Brent A.; Hall, Stephen; Howard, Brittany E.; Neel, Gregory S.; Donald, Carrlene B.; Lal, Devyani; Nagel, Thomas H.; Hayden, Richard E.

doi:10.1016/j.amjoto.2018.11.008

Cited by 11 publications

(9 citation statements)

References 14 publications

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“…Since its introduction in 1993 by Martin et al, 1 the SIF has been increasingly utilized for defects of the oral cavity, oropharynx, face, lateral, and anterior skull base. [2][3][4][5][6][7][8][9] Prior studies have demonstrated that application of the SIF for head and neck reconstruction results in shorter operative times, duration of hospitalization, and decreased hospital costs when compared to free tissue transfer without significant differences in complication rates or functional outcomes. [10][11][12][13] The results of our 10-year study highlight this flaps versatility applied to various defects of the head and neck.…”

Section: Discussionmentioning

confidence: 99%

“…Since it was originally introduced by Martin et al in 1993, 1 the submental island flap (SIF) become a useful addition to the armamentarium of the head and neck reconstructive surgeon. Its use has been demonstrated for defects of the tongue, floor of the mouth, buccal mucosa, palate, oropharynx, hypopharynx, lateral skull base, and face 2–9 . The benefits of the SIF include a pedicled vascular supply, consistent tissue color and texture, minimal donor site morbidity, as well as decreased operative times, duration of hospitalization, and hospital costs when compared to free flaps without compromising functional outcomes 10–13 .…”

Section: Introductionmentioning

confidence: 99%

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The submental island flap in head and neck reconstruction: A 10‐year experience examining application, oncologic safety, and role of comorbidity

Paydarfar

Kahng

Polacco

et al. 2022

Laryngoscope Investig Oto

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Background We present our experience on reconstructive versatility and risk of nodal transfer with the submental island flap (SIF). We also examine the role of comorbidity as a predictor of complications. Methods Retrospective cohort study of patients undergoing SIF over 10‐year period. Comorbidity determined using Adult Comorbidity Evaluation 27 index (ACE‐27). Univariable/multivariable logistic regressions performed to determine association of these characteristics and rates of major complications. Results Fifty‐eight patients underwent SIF reconstruction, 27 (45%) patients had moderate/severe comorbidity, and 24 (41%) experienced major complication. Multivariable analysis identified ACE‐27 scores >2 predictive of major flap complications (OR: 17.38, 95% CI: 1.96–153.74, p = .01) and medical complications (OR: 5.8, 95% CI: 1.11–30.23, p = .037). There were no cases of pathologic nodal transfer. Conclusion The SIF is a versatile flap and oncologically safe in carefully selected patients. The ACE‐27 index is strongly predictive of major postoperative complications. Level of Evidence 4

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The submental island flap in head and neck reconstruction: A 10‐year experience examining application, oncologic safety, and role of comorbidity

Paydarfar

Kahng

Polacco

et al. 2022

Laryngoscope Investig Oto

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“…Dural defects are reconstructed with a fascia graft, acellular dermis, pericardium, or cadaveric dura in order to create a watertight closure. The malleable and thin nature of the pericranium is an optimal choice for subsequent skull base reconstruction especially when it is used in conjunction with other soft tissue and bony reconstructions [6,16,17,18] . However, it lacks a cutaneous component and the mass needed to reconstruct extensive defects with significant volume loss [19] .…”

Section: Locoregionalmentioning

confidence: 99%

Anterior skull base reconstruction: a contemporary review

Naik¹,

Lancione²,

Parikh³

et al. 2021

PAR

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Anterior skull base (ASB) defects present a significant challenge in head and neck reconstructive surgery. The main goal of skull base reconstruction is to create a watertight separation between the intracranial cavity and aerodigestive tract. Successful reconstruction aims to prevent cerebrospinal fluid (CSF) leak, pneumocephalus, and a range of infectious manifestations. Functional outcomes and cosmesis are also critical considerations when developing a reconstructive plan. Advancements with endoscopic endonasal approaches have revolutionized skull base surgery but also have created new reconstructive challenges due to the narrow operative corridor, especially for extensive defects or salvage cases where microvascular free tissue transfer is required. Though a variety of techniques including local, regional, and free flaps have been described, ASB reconstruction remains a difficult undertaking due to the complex anatomy and high risk for post-operative complications. This review provides a comprehensive discussion of available reconstructive techniques that can be used after both open and endoscopic ASB resections to help determine the optimal reconstruction for a variety of defects.

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“…This technique has been well-reported in the literature on reconstruction of open skull base surgery. [17][18][19][20][21][22][23][24][25][26] Limited literature exists, however, on microvascular free tissue transfer using an endoscopic approach. 7,27,28 The existing literature mostly describes personal experience using such techniques that differ in the choice of flap, and the approach toward flap inset as well as pedicle tunneling and anastomosis.…”

Section: Introductionmentioning

confidence: 99%

Anatomic Considerations of Microvascular Free Tissue Transfer in Endoscopic Endonasal Skull Base Surgery

Mady

Kaffenberger

Baddour

et al. 2021

J Neurol Surg B Skull Base

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Objective Though microvascular free tissue transfer is well established for open skull base reconstruction, normative data regarding flap design and inset after endoscopic endonasal skull base surgery (ESBS) is lacking. We aim to describe anatomical considerations of endoscopic endonasal inset of free tissue transfer of transclival (TC) and anterior cranial base resection (ACBR) defects. Design and Setting Radial forearm free tissue transfer (RFFTT) model. Participants Six cadaveric specimens. Main Outcome Measures Pedicle orientation, pedicle length, and recipient vessel intraluminal diameter. Results TC and ACBR defects averaged 17.2 and 11.7 cm2, respectively. Anterior and lateral maxillotomies and endoscopic medial maxillectomies were prepared as corridors for flap and pedicle passage. Premasseteric space tunnels were created for pedicle tunneling to recipient facial vessels. For TC defects, the RFFTT pedicle was oriented cranially with the flap placed against the clival defect (mean pedicle length 13.1 ± 0.6 cm). For ACBR defects, the RFFTT pedicle was examined in three orientations with respect to anterior–posterior axis of the RFFTT: anteriorly, posteriorly, and laterally. Lateral orientation offered the shortest average pedicle length required for anastomosis in the neck (11.6 ± 1.29 cm), followed by posterior (13.4 ± 0.7cm) and anterior orientations (14.4 ± 1.1cm) (p < 0.00001, analysis of variance). Conclusions In ACBR reconstruction using RFFTT, our data suggests lateral pedicle orientation shortens the length required to safely anastomose facial vessels and protects the frontal sinus outflow anteriorly while limiting pedicle exposure through a maxillary corridor within the nasal cavity. With greater understanding of anatomical factors related to successful preoperative flap planning, free tissue transfer may be added to the ESBS reconstruction ladder. Level of Evidence NA

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Submental flap for reconstruction of anterior skull base, orbital, and high facial defects

Cited by 11 publications

References 14 publications

The submental island flap in head and neck reconstruction: A 10‐year experience examining application, oncologic safety, and role of comorbidity

The submental island flap in head and neck reconstruction: A 10‐year experience examining application, oncologic safety, and role of comorbidity

Anterior skull base reconstruction: a contemporary review

Anatomic Considerations of Microvascular Free Tissue Transfer in Endoscopic Endonasal Skull Base Surgery

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