Submental versus platysma flap for the reconstruction of complex facial defects following resection of head and neck tumors.

Jawad Safdar,Chang Fu Sun,Zhen Ning Li,Zhong Fei Xu,Fa Yu Liu,Yousuf Moosa

doi:10.12669/pjms.304.5177

Abstract

To compare the platysma flap with submental flap in terms of tumor and flap characteristics, operative properties and the functional outcomes. 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. 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). 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 70cm(2) with good mouth opening. The submental flap is simpler, faster with a wider range of application and more acceptable functional outcomes.

Highlights

Head and neck tumors are the sixth most common cancer in the world.[1]
The complex facial defects of 30 patients were reconstructed with platysma flap and 35 patients with submental flap
Whereas our study showed one patient with Platysma flap reconstruction had developed partial flap necrosis (3.3%) and none of the patient had complete flap necrosis or necrosis of the distal flap tip. (MOT) mean operation time (6.20+1.47 hours), Mean operation time (MOT) with unilateral neck dissection (6.01+1.3 hours) and MOT with bilateral neck dissection (7.74+1.5 hours) with 63.3% of acceptable function

Summary

Introduction

Head and neck tumors are the sixth most common cancer in the world.[1] The operable cancers are treated with curable resections with radical or selective neck dissection. These radical surgeries results in complex myocutaneous facial, oral and neck defects with severe functional impairment in most of the cases. Their reconstruction with good cosmesis, anatomic integrity and early restoration of mouth function and swallowing is always. Smaller defects heal by secondary intention while for the larger defects the radial forearm flap, anterolateral thigh flaps have been used for 20 years.[2,3] With these techniques are preferred variably in different institutions depending upon the availability of resources, expertise available and the type and the extent of resections performed.[4]

Methods

Results

Conclusion