Submental Flap Reconstruction Research Articles

Management of different kinds of head and neck defects with the submental flap for reconstruction.

Head and neck surgeries often accompany with moderate-sized defects that require time-consuming reconstructions by free flaps. The submental flap is a versatile and time-effective option for reconstruction of orofacial defects providing acceptable cosmetic and functional results without requiring microsurgical techniques. A retrospective case series study of patients who underwent reconstruction with the submental flap between 2009 and 2013 was conducted. There were 36 patients (33 men and 3 women), with a mean age of 56.4 years, enrolled in this study. The primary lesion sites included oral cavity (24 patients), pharynx (8 patients), larynx (2 patients), neck (1 patient) as well as maxillary sinus (1 patient). All flaps were harvested as the myocutaneous flaps. All donor sites were closed primarily without the need of additional surgery. No complete loss of the flap was encountered and two cases developed marginal necrosis of the flap. The submental flap had a reliable pedicle and had minimal donor-site morbidity. It is an excellent flap option for patients with small- to medium-sized defects in head and neck region.

Lateral Skull Base Reconstruction: A Comparison of the Submental Flap to Free and Regional Flaps

Objectives: (1) Recognize reconstructive options for lateral skull base defects. (2) Compare reconstructive techniques, operative times, duration of hospitalization, and need for subsequent flap revisions. Methods: Retrospective review of surgical techniques used at a tertiary academic referral center between 2002 and 2014 to reconstruct lateral skull base composite defects involving facial skin, ear, and temporal bone. Data were analyzed for demographics, tumor characteristics, reconstructive technique, operative time, duration of hospitalization, complications, and outcomes. Results: Thirty-one patients were identified for inclusion. Lateral temporal bone defects resulted from resection of malignant lesions including squamous cell carcinoma (n = 22), basal cell carcinoma (n = 2), melanoma (n = 4), and sarcoma (n = 3). Defects were reconstructed with musculocutaneous free flaps (n = 9), pedicled latissimus dorsi flaps (n = 6), and pedicled submental flaps (n = 16). All cases involved neurosurgery, neurotology, and head and neck surgery services. Although time required for surgical resection was similar, time savings was noticed with submental reconstruction. Compared with free flaps, submental flap reconstruction was associated with significantly reduced total operative time (mean 578 vs 455 minutes; P = .0170) and duration of hospitalization (9 vs 4.9 days; P = .0207). Submental flaps were significantly less likely to require revision debulking procedures (median = 0) compared to free flaps (median = 1.8; P = .00002) and latissimus dorsi flaps (median = 1; P = .0093). There was 100% flap survival. Conclusions: The musculocutaneous submental flap provides an excellent option for reconstruction of lateral skull base defects given its proximity, reliability, ease of harvest, and exceptional color match. Submental flap reconstruction was associated with reduced operative times, duration of hospitalization, and flap revisions.

Free Musculocutaneous Submental Flap for Reconstruction of Anterior Skull Base Defects

Free Musculocutaneous Submental Flap for Reconstruction of Anterior Skull Base Defects

Oncologic Safety of the Submental Flap for Reconstruction in Oral Cavity Malignancies

To evaluate the oncologic safety of the submental flap regarding potential transposition of involved nodes to the reconstruction site and recognize the submental flap as an excellent option for oral cavity reconstruction. Case series with chart review. Tertiary academic referral center. All patients undergoing reconstruction with submental flaps following the resection of primary and recurrent malignancies of the oral cavity between 2002 and 2012 were reviewed. Analysis included tumor location, staging, reconstructive details, postoperative course, and outcomes. Fifty patients were identified having undergone submental flap reconstruction of defects following resection for oral cavity malignancies. No patient had identifiable clinical or radiographic level I nodal involvement preoperatively. Patients' ages ranged from 35 to 88 years (mean, 70 years). American Joint Committee on Cancer staging of patients included stage II (n = 16, 32%), stage III (n = 10, 20%), and stage IVa disease (n = 28, 48%). All patients underwent a level 1A and 1B dissection with removal of the nodal basin and submandibular gland. The prevalence of occult lymph node metastasis involving level 1 was 10%. On follow-up, there were no local recurrences associated with submental flap transposition to the oral cavity. One patient with multifocal oral disease had a tongue recurrence geographically separate from the submental flap reconstruction. There was 100% flap survival. The submental flap provides a rapid and reliable option for oral cavity defect reconstruction. With appropriate management of the level 1 nodal compartment, oncologic outcomes are not compromised.

Oncologic Safety of the Submental Flap for Reconstruction in Oral Cavity Malignancies

Objectives:1) Recognize the submental flap as an excellent option for oral cavity reconstruction. 2) Evaluate the oncologic safety of the submental flap given transposition of potentially involved nodal basins to the reconstruction site.Methods:Retrospective chart review of submental flap reconstructions for oral cavity defects secondary to cancer resections performed at a tertiary referral center between 2001 and 2012. Analysis included tumor location, staging, reconstructive details, postoperative course, and outcomes.Results:Fifty patients were identified having undergone submental flap reconstruction of defects following resection for oral cavity malignancies. No patient had identifiable Level I nodal involvement. Patients’ ages ranged from 35 to 88 (mean 70) years old. Subsites involved were mobile tongue (n=11), buccal mucosa (n=12), retromolar trigone (n=9), hard palate (n=5), lip (n=3), superior alveolar ridge (n=3), and inferior alveolar ridge (3). AJCC staging of patients included stage II (n=16, 32%), stage III (n=10, 20%), and stage IVa disease (n = 28, 48%). All patients underwent a level 1A and 1B dissection with removal of the nodal basin and submandibular gland. The prevalence of occult lymph node metastasis involving level 1 was 10.6%. On follow‐up there were no local recurrences associated with submental flap transposition to the oral cavity. Tongue recurrence occurred in 1 patient with multifocal disease discrete from the submental flap reconstruction. There was 100% flap survival.Conclusions:The submental flap provides a rapid and reliable option for oral cavity defect reconstruction. With appropriate management of the level 1 nodal compartment oncologic outcomes are not compromised.

Reconstruction with Submental Flap for Aggressive Orofacial Cancer

The submental flap was described for head and neck reconstruction more than a decade ago. Its application is confined mainly to nonmalignant diseases or low-grade malignancies, as the submental flap resides in the level I lymphatic drainage region of the neck. The authors report the use of the submental flap for soft-tissue reconstruction in a selected group of patients with aggressive orofacial cancer. From March of 2003 to September of 2005, 10 patients (nine with intraoral squamous cell carcinoma and one with facial angiosarcoma) underwent submental flap reconstruction after surgical extirpation of aggressive orofacial malignancies. The indications were severe comorbidity, old age, the presence of another incurable cancer, and/or the patient's skepticism about undergoing a free flap operation. Of the surviving patients, the median follow-up was 21 months (range, 2 to 37 months). There were no cases of total flap failure, but partial necrosis occurred in two cases. Three patients experienced tumor recurrence, but only one case might have been related to use of the submental flap. Postoperative oral function, in terms of swallowing and speech, was well preserved; conventional dentures were fabricated for four patients. In selected patients with aggressive orofacial cancer, the submental flap is an expedient alternative to free tissue transfer for reconstruction. Nonetheless, indiscriminate use might compromise the oncological outcome, so it cannot be regarded as a standard method of treatment.