OP018: Outcomes of submental artery island flap in oral reconstruction

Abstract

Submental artery island flap (SMIF) described by Martin et al. is a reliable reconstructive option for oral defects. Thorough clearance of suprahyoid lymph nodes during its harvest yields gratifying aesthetic outcome with out any morbidity or oncological compromise. Overall outcomes of SMIF in terms of aesthesis, function and disease free survival. Prospectively assembled data of 136 consecutive patients of SMIF reconstruction for oral cancer at Regional Cancer Centre, Trivandrum, India from October 2004 to December 2009 was analyzed for flap viability, aesthesis, function and locoregional recurrence. There were 78 men and 58 women of mean age ± SD of 55 ± 12 years. The primary site of tumour was tongue in 84%, floor of mouth or lower alveolus in 8%, buccal mucosa in 7% and lip in 1% of patients. Majority (83%) of the patients had a T1 or T2 cancers. Fifty-four (40%) patients had clinically palpable neck nodes preoperatively. Eighty-nine percent of patients had either a Selective or a Modified Radical Neck dissection, whereas remaining 11% had only level I clearance during the flap harvest. Twenty-five (18.3%) patients had pathologically positive neck nodal metastasis. Seven flaps (5%) had partial necrosis which settled without any morbidity. After a median follow up of 40 months (Ranging from 4 months to 88 months), 27 patients (19.8%) recurred – 14 patients (10.2%) at primary site and 13 patients (9.5%) in the neck nodes. Twenty-four percentage of patients (13 of 54) with clinically positive neck node had recurrences, 6 at primary site, 6 at ipsilateral and 1 at the contralateral lymph nodes. Of the 15 patients with clinically positive neck node at level I, 5 recurred. Pre-operative clinical nodal staging was the only significant factor for recurrence on multivariate analysis (significance −0.0001). Submental artery island flap is a reliable, aesthetic, functionally and oncologically safe reconstructive option in carefully selected cases of oral cancer.