Reverse submandibular gland flap: An alternative for reconstruction of medium-sized oral defects

Despite the development of microsurgery, local flaps still play an essential role in the reconstruction of head and neck defects. The submandibular gland flap (SMGF) has proven to be a reliable method for repairing medium-sized defects. It requires a shorter duration of general anesthesia and has fewer donor site complications compared to the free flap. However, the restricted vascular pedicle length limits its application. Retrograde flow is one solution. The authors describe a novel technique of using reverse submandibular gland flap (RSMGF) for the reconstruction of oral cavity defects. Additional vascular pedicle length was obtained by ligating the proximal end and dissecting the distal end of the facial vessels, thus extending its application range. The RSMGF is technically feasible and suitable for repairing medium-sized defects of the oral cavity (cT2 stage tumor) like buccal mucosa, especially for the elderly in poor general condition, for whom free flaps are not applicable.

Reconstruction of Acquired Segmental Mandibular Defects Using Pedicled Mandibular Muscle Flap and Evaluation of Speech Function and Aesthetic Outcomes

PURPOSE

The purpose of this study was to investigate the clinical effect of pedicled mandibular osteomuscular flap in the reconstouring of repair of acquired segmental mandibular defects.

PATIENTS AND METHODS

Thirteen patients with acquired segmental mandibular defects requiring secondary repair were included into the study. Pedicled mandibular osteomuscular flap was applied with strong internal fixation to repair the mandibular defects. The patients' speech, swallowing function, and aesthetic changes were evaluated upon follow-up.

RESULTS

The flaps were viable in all patients. Average speech function score was 7.6±0.6. All patients had a drinking test rating of grade I or II with good masticatory efficiency. The postoperative self-assessment Visual Analog Scale score of appearance was 7.8±0.8.

CONCLUSIONS

Pedicled mandibular osteomuscular flap is a viable choice in the secondary repair and reconstruction of mandibular acquired segmental defects. This flap could achieve better oral function with good aesthetic results.

Reverse Facial-Submental Artery Osteomyocutaneous Flap, a Novel Choice for Previously Operated Huge Alveolar Clefts

Adult previously operated alveolar cleft palate presents a pronounced challenge for optimal surgical reconstruction. This optimal reconstruction dictates the restoration of soft tissues in addition to hard tissues to achieve prime functional results. Regional flaps usually used for the reconstruction of such defects were considered as either bulky or none bone bearing flaps. Furthermore, using free flaps for reconstruction can rise the concerns of increased intraoperative complications and greater suspected donor site morbidities. Here we present three unfavorably previously operated patients with current huge alveolar cleft palates, planned for the reconstruction with reverse facial-submental artery osteomyocutaneous flap. Besides, detailed flap harvesting technique, results, prosthetic restoration post to flap surgery, and follow up are presented in this article. We found the reverse facial- submental osteomyocutaneous flap as a novel and reliable choice for functional reconstruction of challenging huge alveolar cleft palates. The reverse facial-submental flap has not been yet mentioned in the medical literature for the reconstruction of alveolar clefts.

[Lower jaw myxoma in an early age pediatric patient: comprehensive rehabilitation aspects]

The article presents a clinical example of the removal of myxoma in a 14-month-old child with half resection of the mandible, disarticulation and one-stage replacement of the defect with a «Carbopol» endoprosthesis. The period of postoperative follow-up was 6.5 years, during which there were no signs of relapse. 2 years after the operation, complete coverage of the endoprosthesis with bone regenerate was determined, the configuration of which corresponded to the healthy branch of the mandible. The remodeling of the condylar and coronoid processes by this regenerate was noted, as well as the formation of the tooth germ 3.8 above the endoprosthesis.

Clinical Implications of the Submental and Sublingual Arteries in Relation to the Mylohyoid Boutonnière

OBJECTIVE

Mylohyoid musculature may be included in the submental artery flap to protect perforators. However, blood vessels may pass through the mylohyoid muscle and therefore cause bleeding and risk to pedicle or perforator injury when a mylohyoid-containing flap is lifted. The objectives of this study were to identify the prevalence of the submental and sublingual arteries that traverse the mylohyoid and to assess relationships between vasculature transmitted through mylohyoid muscles and mylohyoid boutonnières.

STUDY DESIGN

Cross-sectional human cadaveric study.

SETTING

The West Virginia University School of Medicine human gross anatomic laboratories.

SUBJECTS AND METHODS

A total of 43 intact mylohyoid muscles from 22 cadavers were dissected. The prevalence of submental vasculature perforating the mylohyoid was recorded in addition to the prevalence and contents of mylohyoid boutonnières.

RESULTS

Of 43 mylohyoid muscles, 21 (48.8%) transmitted the submental or sublingual arteries, and 30 (69.1%) possessed boutonnières. One muscle had 2 boutonnières. Of 31 mylohyoid boutonnières, 21 transmitted blood vessels (67.7%). Specifically, 9 transmitted an artery and a vein (29.0%), and 12 transmitted an artery (38.7%). Ten boutonnières (32.3%) were exclusively occupied by fascia.

CONCLUSION

This report identifies the importance of identifying and carefully ligating branches of the submental artery that pierce the mylohyoid during elevation of the submental island flap. This report also identifies that a boutonnière is often present where a submental or sublingual artery is traversing the mylohyoid to supply sublingual glands, tongue, and anterior mandible.

Submental Perforator Flap for Soft-Tissue Reconstruction in Bisphosphonate-Related Osteonecrosis of the Jaws

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) has emerged as an important and increasingly common comorbidity, especially in patients undergoing long-term treatment with high doses of bisphosphonates. The management of BRONJ remains controversial. Surgical treatment is necessary in severe cases. Treatment of the bone requires sequestrectomy or resection. Given the lack of sufficient mucosa to perform the operation and fragility of margins in many patients, local flaps are crucial. We report two cases of stage-3 BRONJ presenting secondary infection with Actinomyces , receiving treatment consisting of marginal resection of the necrotic bone, reinforcement with a reconstruction plate, and reconstruction of soft tissues using a submental perforator artery flap ipsilateral to the lesion. Total cure was achieved in both cases, achieving favorable aesthetic and functional outcomes.

Submental Osteocutaneous Perforator Flap for Maxillary and Mandibular Reconstruction Following Tumor Resection

Many different flaps have been used for reconstruction of the oral mucosa and the maxilla and mandible after tumor resection. These flaps might contain bone and might be free or locoregional. This study presents 2 cases of intraoral reconstruction using a submental osteocutaneous perforator flap to reconstruct the maxilla in one case and the mandible in the other. A reverse-flow flap was used for maxillary reconstruction In these cases, the functional, esthetic, and oncologic outcomes were favorable at 9 and 12 months of follow-up.

The adequacy of lymph node harvest in concomitant neck block dissection and submental island flap reconstruction for oral squamous cell carcinoma; a case series from a single Egyptian institution

BACKGROUND

Squamous cell carcinoma (SCC) is a fairly common tumor of the oral cavity. This tumor may affect any part of the mucosa of the oral cavity especially the tongue, the floor of the mouth and lips. The encountered intra-oral defects after tumor resection are often large and require climbing up the reconstruction ladder to more complex reconstructive options for accepted functional and cosmetic results to be achieved. However, most of the patients are old with medical co-morbidities requiring fast, simple, less morbid reconstructive option such as local flaps. The myocutaneous submental island flap has emerged as a simple and fast reconstructive technique that provides thin, pliable tissue with adequate volume and reliable blood supply. However, one major concern regarding the utility of the submental flap for repair of post-ablative tumor defects is the presumed interference with adequate lymph node neck dissection.

METHODS

In this study, we present a cohort of thirty-six consecutive patients who were operated for oral SCC. All patients were offered submental island flap reconstruction of their resultant defects together with ipsilateral selective neck block dissection of levels I, II, III and IV; and the nodal yield of each level was tested pathologically.

RESULTS

Nodal harvest was ≥ 12 in 88 % of the patients. Complications were encountered in two patients (5.5 %).

CONCLUSION

Our data suggest that adequate cervical lymph nodes dissection, specifically level I and II cervical lymph nodes, can be fulfilled with concomitant submental island flap elevation.

Exclusion of musculature from the submental flap: a contingency plan for facial nerve palsy

Summary:

Submental flap surgery is a useful and versatile reconstructive procedure. Currently, disagreement exists regarding the need to include the anterior belly of the digastric muscle or mylohyoid in the submental flap. The report outlines the value of excluding normal and variant anterior digastric and mylohyoid musculature from the submental flap as a contingency plan for marginal mandibular branch of facial nerve palsy. Also, the article addresses variant anterior digastric musculature, a common anatomical finding, as it relates to the submental flap. The question of whether or not to include the anterior digastric musculature does not necessitate an all-or-none decision. In the case of multiple anterior digastric bellies, some bellies may be included in the flap, whereas others are not. The location of the submental vessels and the desired bulk or contour of the flap should guide the decision of which anterior digastric bellies, if any, are included in the flap.

[Submental island flap: a review of the literature]

The submental island flap is a precious tool in reconstructive surgery. It was described by Martin in 1993, inspired by platysma flaps. In our days, we can find many reliable techniques for this procedure. We reviewed the main studies of the literature that described a total of 528 patients. The rate of partial necrosis was 5.1%, complete necrosis 1.7%, and reversible lesions of the marginal mandibular branch of the facial nerve 1.1%. His versatility makes this flap appropriate for the reconstruction of every part of the face: cheeks, nose, forehead, moustache, beard, and hairs. It can also be used de-epidermised with very good results, for the reconstruction of the buccal cavity, the tongue, the roof of the mouth, the larynx, and the proximal part of the esophagus. The SMAP (Submentalis Artery Perforator flap) is an alternative flap that provides even better cosmetic results. The development of indocyanine green and infrared cameras will allow in a close future to decrease the postoperative complications.

Oral reconstruction with submental flap

BACKGROUND

Submental flap is a useful technique for reconstruction of medium to large oral cavity defects. Hair bearing nature of this flap in men makes it less appropriate. Therefore, deepithelialized variant is introduced to overcome the problem of hair with this flap. Recently, application of this flap has been introduced in maxillofacial trauma patients.

MATERIALS AND METHODS

Deepithelialized orthograde submental flap is used for the reconstruction of oral cavity mucosal defects.

RESULTS

Four cases including two trauma patients and two squamous cell carcinomas (SCCs) of oral cavity were treated using deepithelialized orthograde submental flap. There were no complications in all four patients and secondary epithelialization occurred in raw surface of the flap which was exposed to oral cavity.

CONCLUSION

Deepithelialized orthograde submental flap is very effective in reconstruction of oral cavity in men. The problem of hair is readily solved using this technique without jeopardizing flap blood supply.

Adipogenesis on biphasic calcium phosphate using rat adipose-derived mesenchymal stem cells: in vitro and in vivo

Developing adipose tissue-engineered construct to mend soft tissue defects arising from traumatic injury, tumor resections, and maxillofacial abnormalities is of prime importance in plastic and reconstructive surgical procedures. It is apparent that the clinical outcome of classic techniques like adipose tissue transplantation is unpredictable, with graft resorption, lack of vascularization, and impaired functionality. In this prospective, the concept of tissue engineering was adopted to fabricate a combination product with biphasic calcium phosphate (BCP) and rat adipose-derived mesenchymal stem cells (ASCs) toward the development of an adipose tissue construct. BCP, a combination of hydroxyapatite and α-tricalcium phosphate, was characterized for its physiochemical properties, and ASCs were characterized for their stemness. The cell-ceramic interactions were demonstrated in vitro, whereas adipogenesis was picturesquely depicted by Nile red-stained multilocular adipocyte-like cells. Subsequently, the three-dimensional cell-ceramic-engineered construct was implanted in the rat dorsal muscle for a period of 3 weeks to demonstrate the efficacy of the tissue construct in vivo. Interestingly, the histology of the postimplanted tissue construct revealed the distribution of chicken wire net-like fat cells within the vicinity of the construct. The efficacy of cell transplantation via the scaffold was traced using fluorescent in situ hybridization by labeling the Y chromosome. Thus, the ceramic-based construct may be a good option for reconstruction therapies.

Use of the contralateral retroangular island flap for reconstructing midfacial defects after skin cancer ablation

BACKGROUND

The retroangular flap is usually used to reconstruct small ipsilateral facial defects. The purpose of this study was to explore the use of the contralateral retroangular island flap for reconstructing large midfacial defects.

METHODS

Retroangular flaps raised from the contralateral infraorbital region were used to reconstruct midfacial defects in 12 patients after the resection of skin cancers. The defect ranged in size from 3.0 × 3.0 to 5.0 × 7.0 cm, and the flap skin paddle ranged in size from 2.0 × 4.0 to 4.0 × 6.0 cm.

RESULTS

All of the flaps survived. Patients were followed up for an average of 8.5 months. The vascularity of the flaps was good, and the match in terms of color and texture was excellent. The cosmetic and functional outcomes were satisfactory in all patients.

CONCLUSION

The contralateral retroangular flap is a good alternative for reconstructing moderate to large midfacial defects.