Submental flap: Game changer in oral cancer reconstruction—A study of 1169 cases

Abstract

BackgroundFree‐flap reconstructions (FFRs) are the standard‐of‐care following resections for oral cancer. This study assessed an alternative, the pedicled submental flap (SF) for its versatility, oncological outcomes, and comparative operative time and cost.MethodsThis was a longitudinal prospective study of 1169 patients of oral cancer reconstructed with the SF. Oncological outcomes in terms of recurrence rate and disease‐free survival (DFS), were analyzed in 730 cases with a minimum of 18 months follow‐up. Surgical time and cost were compared between 20 SFs and 14 FFRs performed consecutively.ResultsSF was used to reconstruct defects in the cheek (29.2%), mandible (41.6%), tongue (26.3%) and palate (2.7%) with a 94% flap survival. N+ at level 1 did not adversely affect the recurrence rate as compared with N+ at levels other than level 1 (27.52% vs 29.81%). SFs took a shorter time (186 minutes vs 474 minutes) and cost significantly less than FFRs (P < .0001).ConclusionsSF can reconstruct various oral defects, is sturdy, and esthetically and functionally satisfactory. The procedure time is much shorter than for FFR and costs considerably less. With careful case selection and meticulous clearance, SF reconstruction is oncologically safe even in N+ neck.

Lymph Node Ratio in Head and Neck Cancer with Submental Flap Reconstruction

“…Several prognostic factors following SMAF reconstruction in HNSCC were investigated [ 9 , 15 , 16 ]. Among patients with both tumor resection and SMAF reconstruction, pathological metastasis of lymph node was related to shorter OS and CSS in 160 cases with T1-2 oral SCC [ 15 ], the pathological stage was related to DFS in 1169 cases [ 9 ], and N stage and pathological differentiation were related to locoregional recurrence in 229 cases [ 16 ]. The relationships between LNR and survival results in patients with SMAF reconstruction were not fully investigated because these studies did not investigate LNR [ 9 , 15 , 16 ].…”

“…Among patients with both tumor resection and SMAF reconstruction, pathological metastasis of lymph node was related to shorter OS and CSS in 160 cases with T1-2 oral SCC [ 15 ], the pathological stage was related to DFS in 1169 cases [ 9 ], and N stage and pathological differentiation were related to locoregional recurrence in 229 cases [ 16 ]. The relationships between LNR and survival results in patients with SMAF reconstruction were not fully investigated because these studies did not investigate LNR [ 9 , 15 , 16 ]. Therefore, the present study is thought to contribute to additional research.…”

“…The submental artery flap (SMAF) is a regional flap, which was firstly described in 1993 [ 6 ], was globally developed as a useful flap for medium-sized surgical defects for HNSCC from retrospective and prospective studies [ 7 , 8 ]. The SMAF with both less invasive procedures and good oncologic results was evaluated as a game-changer reconstruction without microvascular anastomosis in comparison to free-flap reconstruction [ 9 ]. The subsite of head and neck cancer is heterogenous.…”

Regional pedicled flap salvage options for large head and neck defects: The old, the new, and the forgotten

“…The submental flap demands an oncologically sound level I neck dissection during harvest if being employed for oral cavity reconstruction. This oncologically sound approach has been extensively studied in oral cavity malignancy reconstruction demonstrating no difference in locoregional control or recurrence rates 35,39–45 . Caution is always advised in cases with level I lymphadenopathy, particularly if there is a concern for extracapsular extension.…”

“…This oncologically sound approach has been extensively studied in oral cavity malignancy reconstruction demonstrating no difference in locoregional control or recurrence rates. 35 , 39 , 40 , 41 , 42 , 43 , 44 , 45 Caution is always advised in cases with level I lymphadenopathy, particularly if there is a concern for extracapsular extension.…”