Submental Versus Platysma Flap for the Reconstruction of Complex Facial Defects Following Resection of Head and Neck Tumors

Abstract

Objective: To compare the platysma flap with submental flap in terms of tumor and flap characteristics, operative properties and the functional outcomes. Methods: A total of 65 patients presented with tumors of head and neck and underwent curative tumor resection with different neck dissections at the Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology of China Medical University; from March 2005 to December 2012 were included in the study. After radical tumor excision and neck dissection the resultant complex defects were reconstructed with either platysma flap or the submental flap. The extent of surgical resection, the type of neck dissection and choice of flap reconstruction was at the discretion of the surgical team. The functional outcomes, operative time and characteristics of both platysma and submental flaps were compared and the statistical tests of significance were applied accordingly. Results: The mean age was 60 years. The complex facial defects of 30 patients were reconstructed with platysma flap and of 35 patients with submental flap. Mean operation time of submental flap including flap harvesting (5.58±1.96hrs) was shorter than platysma flap (6.2±1.4hrs). The majority of the flaps (88-93%) were taken successfully in both groups. Submental flap was associated with significantly higher patients’ satisfaction regarding acceptable functional outcomes (p-value 0.027). The mean reduction in mouth opening was significantly smaller in platysma group (0.37 ±0.18cms) than the submental group (0.47±0.16). Conclusion: This study demonstrates that both platysma and submental flap techniques can be used for the reconstruction of complex facial defects with the acceptable functional outcome. The platysma flap can be harvested to medium size defects up to 70cm2 with good mouth opening. The submental flap is simpler, faster with a wider range of application and more acceptable functional outcomes.

Prognostic factors associated with a restricted mouth opening (trismus) in patients with head and neck cancer: Systematic review

“…These studies were scored with “N/A” on the study participation domain (n = 32; 60%) (Table 2). 5,13,16,18,20,28,30,32,36,37,43,45‐47,51‐58,60,61,64,65,68,69,72,73,75,77 Eleven studies (21%) did not report attrition rate 13,19,33,35,51,55,61,70,72,73,77 . Some did not report the attrition rate because only the patients with complete data were included.…”

“…Four studies (8%) were scored with “N/A" on the outcome measurement domain 14,16,55,60 : two studies did not describe the measurement method 55,60 and two studies used a measurement method that has not been validated (extra‐oral measurements) 14,16 . The majority of the studies were scored with a high risk of bias concerning the statistical analysis and reporting domain (n = 42; 79%) because they lacked a multivariate analysis 5,13,14,17,18,20,28‐37,43,45‐47,51,52,54‐58,60‐68,70,72‐75,77 …”

“…In 16 studies, a single prognostic factor for a decrease in MMO and the patients' perception of difficulties with opening the mouth was analyzed over time (Table 3). 14,16,35,43,46,53‐58,62,65,71,72,74 Regarding patient related factors, a significant effect was found in relation to sex (in one study in the period between before and after treatment) 14 and the −509 genotype 56 . Patients with a homozygous T allele (TT) in the −509 genotype had a greater reduction in MMO than those with a homozygous C allele (CC) or heterozygous C allele (CT).…”

Reconstruction of Soft Tissue Defects with Regional Flaps

“…Furthermore, the resulting scar is discreet and generally very well accepted [ 93 ]. Another advantage of using this fl ap for intraoral and facial reconstruction is that the skin is thin and adapts easily to the defect.…”

Characterization of a Porous BMP-6-Loaded Composite Scaffold for Bone Regeneration in Rat Calvarial Bone Defects

“…Autologous bone grafting is a crucial component of various orthopedic procedures, including oral and maxillofacial surgeries 1) . Although allografts are frequently used during clinical treatment, their utility is limited by the risks of immune rejection, disease transmission, and a lower incorporation rate 2) . Consequently, the regeneration of bone tissue and the repair of bone defects remain challenging.…”