Reconstruction with submental flap for aggressive orofacial cancer.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Chow
Tam-Lin
TL
Hong Kong, S.A.R. From the Divisions of Head and Neck Surgery, Breast Surgery, Reconstructive Surgery, and Maxillofacial and Dental Surgery, United Christian Hospital.
Chan
Tony Tung-Fei
TT
Chow
Tak-Kun
TK
Fung
Siu-Chung
SC
Lam
Siu-Ho
SH
D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005153:Facial Neoplasms / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006394:Hemangiosarcoma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome