The submental flap for oral cavity reconstruction: Extended indications and technical refinements

Abstract

Background and purposeThe submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. However, its role in composite defects involving the jaw is not clearly defined. Indeed, controversy exists about the flap's interference with an oncologically sound neck dissectionPatients and MethodsA total of 21 patients with oral cavity cancers over a three year period were included. All patients underwent surgical resection and immediate reconstruction with submental flap except one patient who had delayed reconstruction with reversed flap. The flap was used for reconstruction of intra-oral soft tissue defect in 13 patients and composite defects in 8 patients.ResultsOf 21 patients 12 were males and 9 were females, age ranged from 32 to 83 years. The primary tumor sites included buccal mucosa (7), tongue (4), alveolar margin (3), floor of mouth (5) and lip (2). Eventually in this study, we adopted completing the neck dissection first before flap harvest. Complete flap loss occurred in 2 whereas 3 patients had partial flap loss. Follow up ranged from 3 to 44 months, one patient died from metastatic disease. Four patients developed neck recurrences.ConclusionThe submental flap is a valid option for reconstruction of intra-oral soft tissue as well as composite oral defects particularly in elderly patients. However, oncologically sound neck dissection should be assured.

Oncological Safety of Submental Artery Island Flap in Oral Reconstruction - Analysis of 229 Cases

“…Although hair growth posed a problem among males patients most of them resolved eventually after the completion of adjuvant radiation therapy. Another complication that can be associated is marginal mandibular nerve paresis which can be avoided by its careful identification and preservation [4,[6][7][8]. The marginal mandibular nerve paresis (4.8 %) documented in the current series was mild and cosmetically insignificant with no functional deficit.…”

“…There is a possibility of inadvertent inclusion of lymphatic tissue harbouring malignant cells into the skin island of the flap or its pedicle [4]. Studies published so far on the oncological safety have largely selected cases with clinically negative nodes [4][5][6][7][8][9][10][11]. Although majority of the patients in our series were N0 , we have raised the flap with utmost care in clinically N+ cases as well.…”

“…Three years later the same was used in oral squamous cell carcinoma by Sterne et al [3].Over the past two decades, this flap has gained acceptance as a reliable and easily available alternative in the reconstruction of oral cavity defects [3][4][5][6][7][8][9][10][11]. It is an axial pattern skin flap based on the submental artery, a consistent branch of facial artery.…”

Reconstructive techniques in head and neck malignancies

“…2 Surgery has been the mainstay for primary management of oral cavity cancer while radiotherapy is offered postoperatively to patients at high risk for loco regional recurrence. 3 Head and neck tumour resection leads to complex defects that are difficult to reconstruct. In addition to the anatomical defects, functional loss, cosmetic disfigurement and accompanying psychosocial effects can be devastating to the patient.…”

“…3 Hence, the study is undertaken to evaluate the pattern of involvement of head and neck malignancies and various surgical modalities used in the management. After tumour board discussion, the best treatment modality for each patient was formulated.…”