Clinical paper
Reconstructive Surgery
The submental island flap in head and neck reconstruction

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Abstract

The authors describe their experience with the submental island flap for the primary correction of head and neck deformities following oncologic surgery, over the past 5 years. The use of this flap is reported in 12 patients, with a mean age of 67 years, requiring facial or intraoral reconstruction. A brief review of the key points and some refinements in the operative technique are discussed. The reconstruction of defects with a submental island flap was successful in every patient. Complications encountered were one case of temporary palsy of the marginal mandibular branch of the facial nerve and one case of orocutaneous fistula. All the donor site defects were closed primarily. The submental island flap is an excellent choice for the reconstruction of head and neck defects because of its reliability, versatility, colour and texture match, and relative ease of application.

Section snippets

Anatomy

The submental island flap, harvested from the suprahyoid region, is an axial patterned flap based on the constant submental branch of the facial artery9. The submental artery arises from the facial artery deep to the submandibular gland. It runs medially on the mylohyoid muscle below the mandibular border, giving off 1–4 cutaneous perforators that pierce the overlying platysma muscle before forming a subdermal plexus that anastomoses extensively with the contralateral branches11. The submental

Methods

The patient is placed supine with the head moderately extended. A spindle-shaped skin paddle is planned horizontally and outlined on the area served by the submental artery, which originates 5.5 cm anterior to the angle of the mandible14. The upper limit of the flap is at least 1 cm behind the mandibular arch, to hide as much of the scar as possible and to prevent inferior lip eversion. The lower limit is determined after a pinch test of the submental skin between two fingers to determine that

Results

The submental island flap was used on 12 patients (8 men and 4 women) treated between August 2001 and May 2005. Every patient underwent primary reconstruction after excision of a malignancy. The mean patient age was 67 years. Two of the 12 cases underwent reconstruction after ablative surgery for squamous cell carcinoma, one in the right pre-auricular region and the other in the left upper alveolar ridge. Three patients had epidermal carcinoma: one involving the left oral tongue and left cheek

Case 1

A 58-year-old man was seen with a T2 squamous cell carcinoma of the posterior cheek mucosa that extended into the maxillo-malar sulcus and tuber maxillae (Fig. 1). Using Jaeger's incision, the patient underwent resection of the carcinoma involving the posterior cheek, anterior part of the tonsils and tuber maxillae, with selective neck dissection (Fig. 2). After tumour resection, a left-side pedicle submental island flap was elevated and transferred to the defect through a subcutaneous tunnel

Discussion

The submental flap is a valuable option for the reconstructive surgeon for orofacial defects following oncological resections. Owing to its reliability, this flap is a good alternative to other cervical skin flaps, such as the platysmal flap or supraclavicular flap, which have limited mobility, unpredictability and leave an unacceptable scar at the donor site. The use of a submental island flap may eliminate the need for a distant flap for head and neck reconstruction. Harvesting is easy to

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