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Accorona R, Di Furia D, Cremasco A, Gazzini L, Mevio N, Pilolli F, Achena A, Iftikhar H, Awny S, Ormellese GL, Dragonetti AG, De Virgilio A. Oral Reconstruction with Locoregional Flaps after Cancer Ablation: A Systematic Review of the Literature. J Clin Med 2024; 13:4181. [PMID: 39064220 PMCID: PMC11278209 DOI: 10.3390/jcm13144181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Introduction: The planning of oral reconstruction after tumor resection is a pivotal point for head and neck surgeons. It is mandatory to consider two aspects: the size of the surgical defect and the complexity of the oral cavity as an anatomical region. We offer a review of the literature that focuses on four types of locoregional flaps that can be profitably used for such reconstruction: infrahyoid (IF), nasolabial (NF), platysma (PF), and submental (SF). Methods: The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review was carried out according to the PICOS acronym through a comprehensive electronic search on PubMed/MEDLINE, Cochrane Library, and Google Scholar databases. For each selected article, we extrapolated eight main parameters, of which all mean values were compared through an ANOVA test. The dimensions of the oral defects were referred to as "small" (<7 cm2), "medium" (7-50 cm2), or "large" (>50 cm2). Results: A total of 139 articles were selected with a total of 5898 patients. The mean ages for each type of flap were not statistically significant (p = 0.30, p > 0.05). Seven sublocations of oral defects were reported: The most common was the tongue (2003 [34.0%] patients), followed by the floor of the mouth (1786 [30.4%]), buccal mucosa (981 [16.6%]), cheek (422 [7.2%]), hard palate (302 [5.1%]), alveolar ridge (217 [3.7%]), and retromolar trigone (187 [3.2%]). The defects were mainly medium-sized (4507 [76.4%] patients), and fewer were small-sized (1056 [17.9%]) or large-sized (335 [5.7%]). Complications were noted, the most frequent of which was flap necrosis, seen in 0.57% of cases. The functional and esthetical results were mainly positive. Conclusions: Locoregional flaps represent a good alternative in medium-sized defects as well as a fairly good alternative in small- and large-sized defects when other options are ruled out.
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Affiliation(s)
- Remo Accorona
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Domenico Di Furia
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Alice Cremasco
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Luca Gazzini
- Division of Otorhinolaryngology—Head and Neck Surgery, “San Maurizio” Hospital, 39100 Bolzano, Italy;
| | - Niccolò Mevio
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Francesco Pilolli
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Andrea Achena
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Haissan Iftikhar
- Department of Otorhinolaryngology, University Hospitals Birmingham, Birmingham B75 7RR, UK;
| | - Shadi Awny
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura 35516, Egypt;
| | - Giorgio Luigi Ormellese
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Alberto Giulio Dragonetti
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Armando De Virgilio
- Department of Organ of Sense, Sapienza University of Rome, 00185 Rome, Italy
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Zhang C, Pandya S, Alessandri Bonetti M, Costantino A, Egro FM. Comparison of split thickness skin graft versus full thickness skin graft for radial forearm flap donor site closure: A systematic review and Meta-analysis. Am J Otolaryngol 2024; 45:104156. [PMID: 38142610 DOI: 10.1016/j.amjoto.2023.104156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/04/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The radial forearm flap (RFF) is one of the most commonly used flaps in reconstructive surgery. Split-thickness skin grafting (STSG) has traditionally been used for closure of the forearm. However, full-thickness skin grafting (FTSG) has gained in popularity to achieve more satisfactory results. The aim of the study is to identify the best RFF donor site closure technique by comparing the functional and aesthetic outcomes of STSG and FTSG. METHODS PubMed and EMBASE databases were queried. Only studies comparing complications rate, functional and aesthetic outcomes between STSG and FTSG were included. The primary outcome was graft failure rate. Secondary outcomes included the aesthetic result and functionality of the forearm/wrist. RESULTS A total of 13 studies were included in this review, accounting for a total of 712 patients with mean age of 60.7 years. Overall, 348 patients underwent FTSG and 377 underwent STSG. The mean follow-up was 14.7 months. The rate of graft failure in FTSG was significantly higher compared to STSG (OR: 2.79, 95 % CI 1.38-5.65, p = 0.004). There was no significant difference in rate of tendon exposure (OR: 0.83, p = 0.65) and infection (OR: 1.37, p = 0.42). Regarding the aesthetic outcome, no significant difference between FTSG and STSG based on observer (SMD = -0.37, p = 0.17) and patient (SMD = -0.016, p = 0.93) assessment, respectively. Overall postoperative functional assessment showed a not severely impaired hand and arm function in both groups. Subjective evaluation of pain was similar between groups. CONCLUSION FTSG is associated with higher risk of graft failure than STSG in RFF donor site closure, without significant improvement in aesthetic results.
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Affiliation(s)
- Casey Zhang
- University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, USA
| | - Sumaarg Pandya
- University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, USA
| | | | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Francesco M Egro
- University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, USA.
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Falade IO, Murphy AI, Switalla KM, Yin RR, Rose JA. Functional donor-site morbidity following reconstruction with pectoralis major flaps: A systematic review. JPRAS Open 2024; 39:278-290. [PMID: 38370000 PMCID: PMC10874169 DOI: 10.1016/j.jpra.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Background Pectoralis major muscle/myocutaneous flaps (PMMFs) are commonly used in reconstructive surgery, but may result in shoulder disability on the donor side. A systematic review evaluating this morbidity could be beneficial for guiding patients and providers considering this procedure. Methods In October 2022, a systematic review of studies evaluating quantitative/qualitative measures of functional morbidity after PMMF was conducted. The results were categorized into PMMF's effect on range of motion (ROM), strength, and ability to complete shoulder-related activities/quality of life. Results Eleven studies were included for analysis, which analyzed standard PMMF and two PMMF variants that spared portions of the muscle. Three of five studies demonstrated reduced shoulder ROM for standard PMMF versus controls lasting at least 4 months after head and neck reconstruction. Two of five studies, including two prospective studies demonstrated reduced shoulder strength for standard PMMF versus controls lasting at least 3 months after surgery. Five of nine studies found significant impairment in the ability to conduct shoulder-related activities, including work, up to one year postoperatively for standard PMMF versus controls. Muscle-sparing PMMF variants exhibited more promising outcomes in some categories. Conclusion Standard PMMF results in prolonged reductions in shoulder ROM and strength, which may impair patients in shoulder-related activities. Other reconstructive options should be considered in patients who frequently participate in such activities. For patients requiring PMMF, muscle-sparing PMMF variants should be considered as alternatives to the standard PMMF.
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Affiliation(s)
- Israel O. Falade
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alexander I. Murphy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Kayla M. Switalla
- Medical School, University of Minnesota - Twin Cities, Minneapolis, MN, USA
| | - Raymond R. Yin
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - John A. Rose
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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Kumar N, Singhal PM, Gora BS, Sharma S, Lakhera KK, Patel P, Singh S, Kumar A, Sharma RG. Submental Artery Island Flaps (SAIF) for Oral Cavity Cancer: Surgical Technique and Tertiary Care Experience. Indian J Otolaryngol Head Neck Surg 2024; 76:819-826. [PMID: 38440498 PMCID: PMC10908732 DOI: 10.1007/s12070-023-04286-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/14/2023] [Indexed: 03/06/2024] Open
Abstract
In oral cancer surgeries, oncological outcomes take precious driverseat. But the copassengers like reconstruction, cosmesis, swallowing and speech outcomes deserve equivalent importance. Submental Artery Island Flaps (SAIF) provide an underutilized and extremely versatile option for reconstruction of defects following early stage oral cavity tumour resections. In this prospective observational analysis, we describe the technique, challenges and outcomes of SAIF at our tertiary care institute. Sixteen patients with Stage I and II oral cavity cancers were enrolled between June 2020 to May 2021. Verrucous carcinomas were five and well differentiated carcinomas were 11 patients. After tumour excision and neck dissections, defects were reconstructed with Pedicled submental flaps. Complications and functional outcomes were analyzed over two years. Nineteen percent were ladies and 81% were gentlemen. Median age was 52 years. Tongue tumours formed majority with 56% cases. Largest skin paddle taken was 36 cm2. Flap survival was 88%. There were variations in venous drainage of flaps which have been depicted in case figures. There was no report of orocutaneous fistula. Grade 3-4 speech satisfaction was achieved by 81.2% patients at 6 months. Swallowing was excellent, grade 4-5 for 100% of patients at 6 months. One patient had distant metastasis at 7 months and died. SRLR (Submental flap Recurrences) and trismus were zero percent at two years. The unexplored field of submental flaps can be used for oral cancer reconstructions in a versatile way. Donor site easy closures, no scars on face, early resumption of daily activities and short hospital stay makes it one of the ideal options in early stage oral cavity defects.
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Affiliation(s)
- Naina Kumar
- Department of Surgical Oncology, SMS Medical College and Attached Group of Hospitals, B 31, Prabhu Marg, Tilak Nagar, Jaipur, 302004 India
| | - Pranav Mohan Singhal
- Department of Surgical Oncology, SMS Medical College and Attached Group of Hospitals, B 31, Prabhu Marg, Tilak Nagar, Jaipur, 302004 India
| | - Bhoopendra Singh Gora
- Department of Surgical Oncology, SMS Medical College and Attached Group of Hospitals, B 31, Prabhu Marg, Tilak Nagar, Jaipur, 302004 India
| | - Shubhra Sharma
- Department of Surgical Oncology, HCG Cancer Hospital, Jaipur, India
| | - Kamal Kishor Lakhera
- Department of Surgical Oncology, SMS Medical College and Attached Group of Hospitals, B 31, Prabhu Marg, Tilak Nagar, Jaipur, 302004 India
| | - Pinakin Patel
- Department of Surgical Oncology, SMS Medical College and Attached Group of Hospitals, B 31, Prabhu Marg, Tilak Nagar, Jaipur, 302004 India
| | - Suresh Singh
- Department of Surgical Oncology, SMS Medical College and Attached Group of Hospitals, B 31, Prabhu Marg, Tilak Nagar, Jaipur, 302004 India
| | - Arjun Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Raj Govind Sharma
- Department of Surgical Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, India
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Steuer CE, Hanna GJ, Viswanathan K, Bates JE, Kaka AS, Schmitt NC, Ho AL, Saba NF. The evolving landscape of salivary gland tumors. CA Cancer J Clin 2023; 73:597-619. [PMID: 37490348 PMCID: PMC10980170 DOI: 10.3322/caac.21807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023] Open
Abstract
Salivary gland cancers are a rare, histologically diverse group of tumors. They range from indolent to aggressive and can cause significant morbidity and mortality. Surgical resection remains the mainstay of treatment, but radiation and systemic therapy are also critical parts of the care paradigm. Given the rarity and heterogeneity of these cancers, they are best managed in a multidisciplinary program. In this review, the authors highlight standards of care as well as exciting new research for salivary gland cancers that will strive for better patient outcomes.
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Affiliation(s)
- Conor E. Steuer
- Department of Hematology-Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Glenn J. Hanna
- Dana Farber Cancer Institute, Harvard University, Cambridge, Massachusetts, USA
| | - Kartik Viswanathan
- Department of Pathology and Laboratory Medicine, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - James E. Bates
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Azeem S. Kaka
- Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Nicole C. Schmitt
- Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Alan L. Ho
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nabil F. Saba
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
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Alzahrani BK, Fatani B, Alshalawi HS, Almutairi RM, AlRfydan HS, Alhindi MM. Survival of Dental Implants Placed in Iliac, Fibula, and Radial Forearm Flaps: A Comprehensive Review. Cureus 2023; 15:e48031. [PMID: 37916255 PMCID: PMC10617750 DOI: 10.7759/cureus.48031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/03/2023] Open
Abstract
Various donor sites have been extensively documented in the literature for bone free flaps in head and neck reconstruction. These include the radius, scapula, rib, ilium, femur, fibula, and metatarsal bone. Among them, the fibula, ilium, and scapula are the most commonly used and studied for placing endosseous implants and for rehabilitation purposes. Each donor site has its own advantages and disadvantages, which depend on factors such as whether the reconstruction is for the maxilla or mandible, the required volume and length of the bone and soft tissue, and the location, extent, and type of defect that needs to be reconstructed. The aim of this current review is to comprehensively assess the existing literature on the survival of implants in fibula, radial, and iliac flaps.
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Affiliation(s)
| | | | | | - Rana M Almutairi
- Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Hesham S AlRfydan
- Oral and Maxillofacial Surgery, Ministry of Health - Health Qassim Cluster, Qassim, SAU
| | - Maryam M Alhindi
- Oral and Maxillofacial Surgery, King Saud University, Riyadh, SAU
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Holcomb AJ, Deschler DG. Regional Flap Donor Sites in Head and Neck Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00065-8. [PMID: 37246029 DOI: 10.1016/j.otc.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Regional flaps are vital to head and neck reconstruction, allowing surgeons to harvest numerous reliable flaps without the need for microvascular anastomosis. These flaps are very useful in cases of vascular depletion and may prove superior to free flaps as a primary option in certain circumstances. Numerous harvest options are available, and the described harvest techniques are safe and straightforward for an experienced reconstructive surgeon to learn. Donor site morbidity is variable depending on flap selection but minimal in many cases. Regional flaps are an excellent option in resource-limited settings or when minimizing reoperation is a high priority.
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Affiliation(s)
- Andrew J Holcomb
- Department of Head & Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street Suite 304, Omaha, NE, USA.
| | - Daniel G Deschler
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
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Fatani B. Radial Forearm Free Flap for Head and Neck Defect Reconstruction: An Up-to-date Review of the Literature. Cureus 2023; 15:e35653. [PMID: 37009378 PMCID: PMC10065458 DOI: 10.7759/cureus.35653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/05/2023] Open
Abstract
The radial forearm free flap has emerged as the mainstay of free flaps for oral cavity soft tissue reconstructions because of its versatility and ability to be used in the reconstruction of large and medium-sized defects. This flap is commonly used to restore head and neck defects, including full-thickness lip and oral cavity defects. This flap offers the opportunity to cover severe defects of the facial region due to its long vascular pedicle and elasticity. In addition to its ease of being harvested, the radial forearm free flap provides a sensate, pliable, and thin skin paddle with a long vascular pedicle. However, it can cause severe morbidity at the donor site, mainly due to exposure of the flexor tendon that results from a failed harvesting of the skin graft, changed sensation in the radial nerve, aesthetic deformity, and reduced range of motion and grip strength. This article aims to review all the up-to-date studies discussing the use of radial forearm free flap in head and neck reconstruction.
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Paydarfar JA, Kahng PW, Polacco MA, Zhao W. The submental island flap in head and neck reconstruction: A 10-year experience examining application, oncologic safety, and role of comorbidity. Laryngoscope Investig Otolaryngol 2022; 7:361-368. [PMID: 35434339 PMCID: PMC9008180 DOI: 10.1002/lio2.741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/26/2021] [Accepted: 01/08/2022] [Indexed: 11/07/2022] Open
Abstract
Background We present our experience on reconstructive versatility and risk of nodal transfer with the submental island flap (SIF). We also examine the role of comorbidity as a predictor of complications. Methods Retrospective cohort study of patients undergoing SIF over 10-year period. Comorbidity determined using Adult Comorbidity Evaluation 27 index (ACE-27). Univariable/multivariable logistic regressions performed to determine association of these characteristics and rates of major complications. Results Fifty-eight patients underwent SIF reconstruction, 27 (45%) patients had moderate/severe comorbidity, and 24 (41%) experienced major complication. Multivariable analysis identified ACE-27 scores >2 predictive of major flap complications (OR: 17.38, 95% CI: 1.96-153.74, p = .01) and medical complications (OR: 5.8, 95% CI: 1.11-30.23, p = .037). There were no cases of pathologic nodal transfer. Conclusion The SIF is a versatile flap and oncologically safe in carefully selected patients. The ACE-27 index is strongly predictive of major postoperative complications. Level of Evidence 4.
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Affiliation(s)
- Joseph A. Paydarfar
- Geisel School of Medicine at DartmouthHanoverNew HampshireUSA
- Section of Otolaryngology, Audiology & Maxillofacial Surgery, Department of SurgeryDartmouth‐Hitchcock Medical CenterLebanonNew HampshireUSA
| | - Peter W. Kahng
- Department of OtolaryngologyUniversity of Michigan Hospitals and Health CentersAnn ArborMichiganUSA
| | | | - Wenyan Zhao
- The Dartmouth Institute for Health Policy and Clinical PracticeLebanonNew HampshireUSA
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Chen J, Fang J, Zhong Q, Feng L, He S, Ma H, Hou L, Lian M, Wang R, Shen X, Yang Y. Flap Reconstruction of the Oropharyngeal Defect After Tumor Resection via Combined Transcervical and Transoral Approach in Patients With HPV-Positive and -Negative Oropharyngeal Squamous Cell Carcinoma. Front Oncol 2022; 12:857445. [PMID: 35280724 PMCID: PMC8907513 DOI: 10.3389/fonc.2022.857445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate a novel surgical approach of combined transcervical parapharyngeal space (PPS) with the transoral approach to dissect oropharyngeal cancer. Methods 31 patients who were pathologically diagnosed with oropharyngeal cancer and had undergone surgical treatment in Beijing Tongren Hospital during June 2018 and December 2020 were enrolled. All patients were squamous cell carcinoma patients. There were 25 males and 6 females, and the age ranged between 44 and 70 years old. The number of patients with T1, T2, T3, and T4 stage disease was 8, 15, 8, and 0, respectively, according to the American Joint Committee on Cancer staging method, 8th edition. After the dissection of the submandibular and cervical lymph nodes, the parapharyngeal space was exposed, and the parapharyngeal space lymph node and the outer borderline of the tumor were dissected, and then the inner borderline of the tumor was dissected via a transoral approach; the tumor was dissected en bloc, and the defects were reconstructed with the flap from the neck through the parapharyngeal space. Results Among the patients enrolled, 21 were HPV positive and 10 were HPV negative. 8 patients were free of lymph node metastasis. The tumor resection margins were negative in all 31 patients. Safe and sufficient excision of tumors was feasible by this new surgical approach, avoiding complications associated with mandibulotomy or lip-splitting. All patients had no obvious dysfunctions of swallowing and voice. By the time of this follow-up, none died caused by OPSCC, and only two patients suffered from local recurrence. The 3-year survival rate is 100%, and the 3-year recurrence-free survival rate is 84.58%. Conclusion The surgical approach of combined transcervical parapharyngeal space with the transoral approach was effective and safe. On this basis, this approach has the advantage of fewer postoperative complications and better functional results.
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Affiliation(s)
- Jiaming Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jugao Fang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qi Zhong
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ling Feng
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shizhi He
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongzhi Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lizhen Hou
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Meng Lian
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ru Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xixi Shen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yifan Yang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Larson AR, Abt NB, Deschler DG. Submental Island Flap After Prior Contralateral Neck Dissection: A Case Series and Technical Considerations. Ann Otol Rhinol Laryngol 2021; 131:1164-1169. [PMID: 34823369 DOI: 10.1177/00034894211059307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The submental island flap is a dependable workhorse in head and neck reconstruction. However, the viability of this flap has not been established for oral cavity reconstruction when a contralateral neck dissection has already been performed in an earlier surgical setting. The aim of this study is to highlight technical considerations and outcomes of this approach with a small case series. METHODS Three cases of oral cavity reconstruction with a submental island flap elevated in the context of a prior contralateral neck dissection are presented. RESULTS In all cases, a doppler was used to identify the maintenance of the submental perforator in the neck opposite the previous neck dissection. In 2 cases, level IA was included within the dissection field of the previous neck dissection. Additionally, the old neck scar was included within the skin paddle of the submental island flap in 2 cases. In all cases, excellent healing of the flap was observed without partial or complete loss. CONCLUSIONS The submental island flap appears to be a reliable reconstruction when a previous contralateral neck dissection has been performed, even when level IA was included in the prior dissection.
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Affiliation(s)
- Andrew R Larson
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Nicholas B Abt
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Hanson-Viana E, Rendón-Medina MA, Mendoza-Vélez MDLÁ, Pacheco-López RC, Palacios-Juárez J. Refinements of the submental island flap donor site: a literature review and comparison among surgical specialties. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bondi S, Vinciguerra A, Lissoni A, Rizzo N, Barbieri D, Indelicato P, Abati S. Mucosal Melanoma of the Hard Palate: Surgical Treatment and Reconstruction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3341. [PMID: 33804881 PMCID: PMC8036556 DOI: 10.3390/ijerph18073341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/17/2021] [Accepted: 03/19/2021] [Indexed: 12/02/2022]
Abstract
Mucosal melanomas of the head and neck region are uncommon pathologies that can affect the oral cavity, and are characterized by a high rate of mortality. Considering the lack of knowledge regarding risk and prognostic factors, current best clinical practice is represented by a large surgical excision with disease-free margins, eventually associated with a reconstructive flap. Indeed, given the frequent necessity of postoperative radiotherapy and fast healing process, a reconstruction of the surgical gap is advisable. Even if several flaps have been most commonly used, the submental island flap represents a valid alternative thanks to local advantages and similar oncologic outcomes compared to free flaps.
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Affiliation(s)
- Stefano Bondi
- Otorhinolaryngology—Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy; (A.V.); (D.B.); (P.I.)
| | - Alessandro Vinciguerra
- Otorhinolaryngology—Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy; (A.V.); (D.B.); (P.I.)
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
| | - Alessandra Lissoni
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
- Department of Dentistry and Stomatology IRCCS San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy
| | - Nathalie Rizzo
- Pathology Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, 20100 Milano, Italy;
| | - Diego Barbieri
- Otorhinolaryngology—Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy; (A.V.); (D.B.); (P.I.)
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
| | - Pietro Indelicato
- Otorhinolaryngology—Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy; (A.V.); (D.B.); (P.I.)
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
| | - Silvio Abati
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
- Department of Dentistry and Stomatology IRCCS San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy
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Holcomb AJ, Richmon JD. Transoral robotic salvage oropharyngectomy with submental artery island flap reconstruction. Head Neck 2020; 43:E13-E19. [DOI: 10.1002/hed.26543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/30/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Andrew J. Holcomb
- Department of Otolaryngology Massachusetts Eye and Ear, Harvard Medical School Boston Massachusetts USA
| | - Jeremy D. Richmon
- Department of Otolaryngology Massachusetts Eye and Ear, Harvard Medical School Boston Massachusetts USA
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Amin AA, Jamali OM, Ibrahim AS, Rifaat MA, Zedan MH. The contralateral based submental island flap for reconstruction of tongue and floor of mouth defects: Reliability and oncological outcome. Head Neck 2020; 42:2920-2930. [PMID: 32757321 DOI: 10.1002/hed.26338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/29/2020] [Accepted: 05/30/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Submental artery island flap (SIF) is a viable alternative to free flaps for selected oral-cavity defects, however, concerns about its oncologic safety still exists. A novel harvesting technique and its outcome is described in here. METHODS This is a prospective study for patients with lateralized oral tongue and/or floor of mouth (FOM) cancers who undergone reconstruction using pedicled SIF based on contralateral submental vessels (CSIF) following resection. RESULTS Forty-one patients were included. Twenty-four patients had T2, 13 had T3, and 4 had T1 tumors. The largest flap skin paddle was 15 × 9 cm. One patient sustained complete and five sustained partial flap loss. Three patients developed tongue tethering. Median follow-up was 13.6 months. Locoregional recurrence occurred in 11 patients (26.8%); 6 oral-cavity recurrences (14.6%), 6 ipsilateral, and 1 contralateral neck recurrences (2.4%). CONCLUSION CSIF is a reliable flap that addresses the oncologic controversy and overcomes the disadvantages of ipsilateral flap.
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Affiliation(s)
- Ayman A Amin
- Department of Surgical Oncology, Division of Head and Neck Surgery, National Cancer Institute, Cairo University, Cairo, Egypt.,Department of Surgical Oncology, Shefa Al-Orman Cancer Hospital, Luxor, Egypt
| | - Omer M Jamali
- Department of Surgical Oncology, Division of Head and Neck Surgery, National Cancer Institute, Cairo University, Cairo, Egypt.,Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hodeidah University, Hodeidah, Yemen
| | - Ahmed S Ibrahim
- Department of Surgical Oncology, Division of Head and Neck Surgery, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed A Rifaat
- Department of Surgical Oncology, Division of Head and Neck Surgery, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed H Zedan
- Department of Surgical Oncology, Division of Head and Neck Surgery, National Cancer Institute, Cairo University, Cairo, Egypt.,Department of Surgical Oncology, Shefa Al-Orman Cancer Hospital, Luxor, Egypt
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Merchant Y, Subash A, Rao V. In Reference to The Submental Flap for Head and Neck Reconstruction: Comparison of Outcomes to the Radial Forearm Free Flap. Laryngoscope 2020; 130:E528. [PMID: 32598031 DOI: 10.1002/lary.28833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Yash Merchant
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bangalore, 560027, India
| | - Anand Subash
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bangalore, 560027, India
| | - Vishal Rao
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bangalore, 560027, India
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