The management of submental flap in the reconstruction of the oral cavity and skin of face defects

Abstract

One of the most current problems in surgical treatment of the head and neck malignant neoplasms is the necessity for plastic replacement of defects that occur after tumor removal. The management of a submental flap in 34 patients with squamous cell cancer of the oral cavity and skin cancer of the face has been analyzed. There were 29 males and 5 females. The average age of patients was 56.9±5.23 years. The squamous cell cancer of the tongue was diagnosed in 18 patients, the floor of mouth — 7, the mucous of the cheek — 5, the retromolar triangle — 1 and skin basaloma of face in 3 patients. Single-stage reconstruction of postoperative defects after removal of the primary tumor was carried out simultaneously with the neck dissection. The submental flap with orthograde blood supply was used for reconstruction of the oral cavity defects in 31 patients and submental flap with the retrograde variant of blood supply was used to replace skin defects of face in 3 patients. The flap, which included skin, subcutaneous fat and the anterior belly of digastric muscle was used in 25 patients. A submental flap that included skin, subcutaneous fat, anterior belly of digastric muscle, and the fragment of the mylohyoid muscle was used in 9 patients. Total flap failure was observed in 2 patients and partial flap failure was observed in 3 patients. To replace the defect the supraclavicular artery skin and fascial flap were used in patients with total flap failure. Completion of primary plastics was 94%. Salivary fistula was observed in 2 patients and orostoma was not observed. Oral nutrition was restored for all 33 patients with oral cancer after surgery on 7–8 day. The hematoma in the donor’s site was diagnosed in 1 patient and partial sutures failure was observed in 4 patients. The obtained results allow us to recommend the submental flap as an effective way to reconstruct the defects of the oral cavity and the skin of the face after the removal of malignant tumors.