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Varghese BT, Thomas G, Sudha P. Painful refractory erosive tongue lichen planus with malignant transformation. Oral Oncol 2024; 148:106624. [PMID: 37984185 DOI: 10.1016/j.oraloncology.2023.106624] [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: 11/04/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023]
Abstract
We present a recent case of long standing erosive tongue lichen planus successfully treated by wide excision and reconstruction with a submental artery island flap. Erosive Lichen Planus is a progressive indolent potentially malignant condition that tends to end up with severe somatic or even neuropathic pain and malignant changes towards its final stages as elaborated in the presented commentary.
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Affiliation(s)
- Bipin T Varghese
- Regional Cancer Centre, Thiruvananthapuram 695011, Kerala, India.
| | - Gigi Thomas
- Regional Cancer Centre, Thiruvananthapuram 695011, Kerala, India
| | - P Sudha
- Regional Cancer Centre, Thiruvananthapuram 695011, Kerala, India
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Lin YS, Kuan CH, Lo C, Tsai LW, Wu CH, Huang CH, Yeong EK, Tai HC, Huang CS. Is Immediate Lymphatic Reconstruction on Breast Cancer Patients Oncologically Safe? A Preliminary Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5385. [PMID: 37941816 PMCID: PMC10629743 DOI: 10.1097/gox.0000000000005385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/20/2023] [Indexed: 11/10/2023]
Abstract
Background In breast cancer patients receiving axillary lymph node dissection (ALND), immediate lymphatic reconstruction (ILR) with lymphovenous anastomosis is an emerging technique for reducing the risk of arm lymphedema. However, the oncologic safety of surgically diverting lymphatic ducts directly into venules in a node-positive axilla is still a concern of inadvertently inducing metastasis of remaining cancer cells. This study aimed to assess the oncologic safety of ILR. Methods From January 2020 to January 2022, 95 breast cancer patients received ALND, and 45 of them also received ILR. Patients with recurrent cancer, with follow-up less than 12 months, and with missed data were excluded. Variables were compared between ILR and non-ILR groups, and the outcome of interest was the rate of distant recurrence after follow-up for at least 1 year. Results Thirty-four patients in the ILR group and 32 patients in the non-ILR group fulfilled the inclusion criteria for analysis. No statistically significant difference was noted between groups in terms of age, body mass index, type of breast surgery, pathologic cancer staging, histologic type and grade of breast cancer, molecular subtypes, frequency of axillary lymph node metastasis, or adjuvant therapy. For the patients receiving follow-up for at least 1 year, no statistically significant difference was found in terms of distant recurrence rates between ILR and non-ILR groups (P = 0.44). Conclusion For breast cancer patients receiving ALND, ILR with lymphovenous anastomosis is oncologically safe, within an average follow-up period of 21 months.
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Affiliation(s)
- Ying-Sheng Lin
- From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Chen-Hsiang Kuan
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chiao Lo
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Wei Tsai
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Chien-Hui Wu
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chieh-Huei Huang
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Eng-Kean Yeong
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Hao-Chih Tai
- From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chiun-Sheng Huang
- From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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Eldweny H. The reliability of submental flap for soft tissue reconstruction in patients with carcinoma of the oral cavity. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1374-1380. [PMID: 37246092 DOI: 10.1016/j.ejso.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND The submental island flap (SIF) is a reliable option for reconstruction of the defects of the oral cavity following cancer resection. Advantages include reliable axial vascular pedicle, low donor site morbidity, good functional and cosmetic outcome, shorter operative time and lower cost compared to free flap reconstruction. MATERIALS AND METHODS A total of 32 consecutive patients with carcinoma of the oral cavity were included in this study. All patients underwent resection and immediate reconstruction with SIF pedicled the submental vessels. Donor and recipient site morbidity, functional outcome, and locoregional recurrences are reported. RESULTS The study included 22 males (69%) and 10 females. The mean age was 54 years (range of 31-79 years). The most common primary tumor site was the tongue (15 patients, 47%), followed by the buccal mucosa, alveolar margin, floor of mouth, lower lip and hard palate. In 25 patients (78%) the flap survived completely. Complete flap loss occurred in one patient (3%). Six patients (19%) developed complications related to flap vascularity. 21 patients (66%) resumed normal diet, while 11 patients (34%) tolerated only soft diet. Over a median follow up was of 15 months (range of 3-62 months), 21 patients (66%) are alive and disease free, while 8 patients died, of whom 4 of locoreginal recurrences. CONCLUSIONS SIF is reliable for reconstruction of the intraoral soft tissue defects following cancer resection. The functional and cosmetic outcomes are satisfactory and donor site morbidity is low. Careful patient selection is necessary for favorable outcome.
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Affiliation(s)
- Hany Eldweny
- National Cancer Institute, Surgical Oncology Department, Head and Neck Division, Cairo University, Egypt.
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Miao HJ, Sun SK, Tian YY, Yang YQ, Wang SH, Bai S, Chen W, Mao C, Liang SX, Yan YB. Oncologic safety of the pedicled submental island flap for reconstruction in oral tongue squamous cell carcinoma: An analysis of 101 cases. Oral Oncol 2023; 140:106395. [PMID: 37068412 DOI: 10.1016/j.oraloncology.2023.106395] [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: 10/09/2022] [Revised: 01/31/2023] [Accepted: 04/10/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To evaluate whether the pedicle submental island flap (SIF) can be safely used in the oral tongue squamous cell carcinoma (OTSCC) patients with pathologically node-positive (pN+) neck, especially pN+ at level I. METHODS Retrospectively, 101 OTSCC patients with SIF reconstruction were enrolled. Oncological outcomes included the total locoregional recurrence, the SIF related locoregional recurrence (SRLR) which referred to the local recurrence at flap and ipsilateral neck recurrence at level I, recurrence free survival (RFS), overall survival (OS), and disease specific survival (DSS). RESULTS Sixty-one patients were pathologically node-negative (pN0) and 40 were pN+. Thirteen patients experienced locoregional recurrence, of which 5 had a SRLR. The pN+ group had a significantly higher locoregional recurrence rate, lower 5-year RFS, OS and DSS than pN0 group (P < 0.05). Patients with pN0 had a significantly higher neck RFS when compared to those with pN+ either at level I (P = 0.005) or at other levels (P < 0.001). However, the neck RFS was similar between the two subgroups of pN+ (P = 0.550). Especially, patients with pN+ at level I had a significantly higher SRLR rate (P = 0.006) compared to those with pN0 at level I. Multivariate analysis showed that pN+ was an unfavorable factor for tumor recurrence and OS. CONCLUSION Our data did not support the use of SIF in OTSCC patients with pN+ neck at level I due to an significantly increased SRLR rate compared to those with pN0 neck at level I.
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Affiliation(s)
- He-Jing Miao
- Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China; Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Shao-Kang Sun
- Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China; Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Yuan-Yuan Tian
- Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China; Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Yun-Qi Yang
- Stomatology Center, The First People's Hospital of Shunde, No.1 Azi Road, Shunde District, Foshan 528000, PR China
| | - Shi-Hua Wang
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin 300041, PR China; Department of Operative Dentistry and Endodontics, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Shuang Bai
- Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China; Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Wei Chen
- Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China; Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Chi Mao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing 100081, PR China.
| | - Su-Xia Liang
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin 300041, PR China; Department of Operative Dentistry and Endodontics, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China.
| | - Ying-Bin Yan
- Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China; Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin 300041, PR China.
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Jamali OM, Shindy MI, Noman SA, Beheiri MG, Amin AA. Oncological outcome of contralateral submental artery island flap versus primary closure in tongue squamous cell carcinoma: randomized non-inferiority clinical trial. Int J Oral Maxillofac Surg 2023; 52:152-160. [PMID: 35672195 DOI: 10.1016/j.ijom.2022.05.002] [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: 08/24/2021] [Revised: 03/18/2022] [Accepted: 05/10/2022] [Indexed: 01/11/2023]
Abstract
The aim of this study was to test the non-inferiority of the contralateral submental island flap (CSIF) compared with primary closure (PC) regarding local recurrence after partial glossectomy in patients with oral tongue squamous cell carcinoma (OTSCC). This open-label, non-inferiority randomized controlled trial enrolled patients with cT1-2 lateralized OTSCC. The primary outcome was local recurrence by 12 months postoperative. Non-inferiority would be declared if the upper limit of the two-sided 95% confidence interval (CI) for the proportion difference in local recurrence between the two groups did not exceed a non-inferiority margin of 15.0%. The functional outcome was assessed for superiority through secondary outcomes. In the intention-to-treat analysis, the local recurrence rate was 3.1% (1/32) in the CSIF group versus 9.4% (3/32) in the PC group; the proportion difference was - 6.3% (95% CI -18.0% to 5.5%). In the per-protocol analysis, the local recurrence rate was 3.1% (1/32) versus 3.3% (1/30); the proportion difference was - 0.2% (95% CI -9% to 8.6%). Speech was significantly superior in the CSIF group (P = 0.001). In conclusion, the CSIF was found to be non-inferior to PC regarding local recurrence at 1 year. A limitation of this study is the relatively large non-inferiority margin and consequently relatively small sample size. Further studies with a smaller non-inferiority margin and therefore larger sample size are needed to validate these findings.
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Affiliation(s)
- O M Jamali
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hodeidah University, Hodeidah, Yemen.
| | - M I Shindy
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S A Noman
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Sana'a University, Sana'a, Yemen
| | - M G Beheiri
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - A A Amin
- Department of Surgical Oncology, Division of Head and Neck Surgery, National Cancer Institute, Cairo University, Cairo, Egypt
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Philip J, Mizen K, Singh M, Karzai L, Saunders K, Bazira P. The submental island flap - should we be worried about lymph node transfer? An anatomical and histological study. Br J Oral Maxillofac Surg 2023; 61:221-226. [PMID: 36990879 DOI: 10.1016/j.bjoms.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/03/2023] [Accepted: 01/18/2023] [Indexed: 03/03/2023]
Abstract
The submental island flap has been increasing in popularity for both oncological and non-oncological reconstruction of the head and neck. However, the original description of this flap left it with the unfortunate designation as a lymph node flap. There has thus been significant debate on the oncological safety of the flap. In this cadaveric study the perforator system suppling the skin island is delineated and the lymph node yield of the skeletonised flap is analysed histologically. A safe and consistent approach to raising the perforator flap modification is described and the pertinent anatomy, and an oncological discussion with regards to the submental island perforator flap histological lymph node yield discussed. Ethical approval was received from Hull York Medical School for the anatomical dissection of 15 sides of cadavers. 6 x 4cm submental island flaps were raised following a vascular infusion of a 50/50 mix of acrylic paint. The flap size mimics the T1/T2 tumour defects these flaps would usually be used to reconstruct.The submental vascular anatomy, including length, diameter, venous drainage patterns, and the skin perforator system was documented. The dissected submental flaps were then histologically examined for the presence of lymph nodes by a head and neck pathologist at Hull University Hospitals Trust department of histology. The total length of the submental island arterial system, the distance from where the facial artery branches off from the carotid to the submental artery perforator entering the anterior belly of digastric or skin, averaged 91.1mm with anaverage facial artery length of 33.1mm and submental artery of 58mm. Vessel diameter for microvascular reconstruction was 1.63mm for the submental artery and 3mm for the facial artery. The most common venous anatomy drainage pattern was the submental island venaecomitantes draining to the retromandibular system then to the internal jugular vein. Almost half the specimens had a dominant superficial submental perforator allowing the ability to raise this as a skin only system. There were generally 2-4 perforators passing through the anterior belly of digastric to supply the skin paddle.73.3% (11/15) of the skeletonised flaps contained no lymph nodes on histological examination. The perforator version of the submental island flap can be safely and consistently raised with inclusion of the anterior belly of digastric. In approximately half the cases a dominant superficial branch allows for a skin only paddle. Due to the vessel diameter, free tissue transfer is predictable.Venous anatomy is variable and care needs to be taken when raising this flap. The skeletonised version of the perforator flap is largely devoid of nodal yield and on oncological review a 16.3% recurrence rate is equivalent to current standard treatment.
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Zhao J, Zeng W, Li K, Huang J, Tong MCF, Deng L, Zhang X. Repair of postoperative defects of oral cancer with submental island flaps based on vascular pedicles of different states: a multicenter retrospective study. Sci Rep 2022; 12:21257. [PMID: 36481648 PMCID: PMC9731967 DOI: 10.1038/s41598-022-24293-4] [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] [Received: 05/11/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Submental island flap has certain advantages in repairing postoperative defects of oral cancer, and it can often achieve similar or even better effects compared with those of the free tissue flap. In this study, according to the different characteristics of patients and postoperative defects of oral cancer, submental island flaps with different states of vascular pedicle were prepared, and its repair methods, safety, and clinical effects in treating postoperative defects of oral cancer were investigated. 83 patients with oral cancer who met the inclusion criteria were selected. According to the different characteristics of the patients and postoperative defects of oral cancer, the traditional submental island flap vascular pedicle was modified into three different states: submental artery perforator flap, vascular pedicled flap with the anterior belly of digastric muscle but without the submandibular gland (SIF with anterior belly of DM), and vascular pedicled flap with the anterior belly of the digastric muscle and the submandibular gland (SIF with anterior belly of DM and SG). The types of the submental artery and the drainage vein, flap survival, and complications, were observed. The flap was successfully harvested for all patients, and the submental artery could be found or separated for all of them, with the venous drainage to the internal jugular vein in 57 (57/83, 68.67%), to the external jugular vein in 18 (18/83, 21.69%), and to the anterior jugular vein in eight (8/83, 9.64%) cases. Submental artery perforator flap was used for 11 cases, complete necrosis occurred in two cases (2/11, 18.18%), partial necrosis occurred in one case (1/11, 9.09%); SIF with anterior belly of DM was used for 49 cases, complete necrosis occurred in one case (1/49, 2.04%), partial necrosis occurred in four cases (4/49, 8.16%); SIF with anterior belly of DM and SG was used for 23 cases, including chimeric flap combining the submental island flap and the submandibular gland used for 15 cases, there were no cases of complete or partial necrosis. Submental island flap was effective in repairing postoperative defects of oral cancer. Submental island flaps with three different states of vascular pedicle could repair oral cancer-affected tissues with different defect characteristics.
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Affiliation(s)
- Jiuzhou Zhao
- Department of Otolaryngology, Longgang E.N.T Hospital, Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, No. 3004, Longgang Avenue, Shenzhen, Guangdong People’s Republic of China
| | - Wen Zeng
- Department of Head and Neck, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi People’s Republic of China
| | - Ke Li
- Department of Otolaryngology, Longgang E.N.T Hospital, Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, No. 3004, Longgang Avenue, Shenzhen, Guangdong People’s Republic of China
| | - Jing Huang
- Department of Institute of Cancer Research, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi People’s Republic of China
| | - Michael C. F. Tong
- grid.10784.3a0000 0004 1937 0482Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - Lifei Deng
- Department of Head and Neck, Jiang Xi Caner Hospital, No. 519, Beijing East Road, Nanchang, Jiangxi People’s Republic of China
| | - Xiangmin Zhang
- Department of Otolaryngology, Longgang E.N.T Hospital, Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, No. 3004, Longgang Avenue, Shenzhen, Guangdong People’s Republic of China
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Shaikh M, Kumar K, Kannan R, Doctor A, Pradhan SA. Submental Flap in the Reconstruction of Palatal Defects. Indian J Otolaryngol Head Neck Surg 2022; 74:6164-6169. [PMID: 36742641 PMCID: PMC9895638 DOI: 10.1007/s12070-021-02833-0] [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: 08/04/2021] [Accepted: 08/22/2021] [Indexed: 02/07/2023] Open
Abstract
Amongst oral cancers, malignancies of the palate and the upper gingivo-buccal complex are relatively uncommon. Following resection, defects in the palate lead to a nasal speech and nasal regurgitation on swallowing. This is best overcome with a prosthetic obturator which occludes the palatal defect and has dentures for the upper alveolus. It may not be possible to fit a prosthetic obturator in edentulous patients and in patients with trismus. Microvascular free flaps though commonly used for such defects, are time consuming, expensive and require a specialised setup. This study assesses the submental flap for its feasibility to repair palatal defects, the sturdiness of the flap, its functional outcome and the oncological safety in using the flap. This is a retrospective analysis of 46 patients, where palatal defects for oral cancers were reconstructed with the submental flap. Oncological safety was studied in 41 patients with a median follow-up of 34.5 months. 20 patients were studied for their functional outcomes using the parameters, adopted from the University of Washington-Quality of Life questionnaire. Complete flap loss was seen in 4 (8.7%) patients while 2 (4.35%) patients had minor dehiscence. No donor site morbidity was reported. Locoregional Recurrences and distant metastasis were noted in 13 of the 41 patients studied. The mean score was highest for speech at 95.5% while the lowest mean score was for mouth opening at 42.5%. The submental flap is an effective and reliable alternative for the reconstruction of palatal defects.
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Affiliation(s)
- Mohsin Shaikh
- Department of Surgical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Kanav Kumar
- Department of Surgical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Rajan Kannan
- Department of Surgical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | | | - Sultan A. Pradhan
- Department of Surgical Oncology, P.D. Hinduja Hospital and Breach Candy Hospital, Prince Aly Khan Hospital, Mumbai, India
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Suzuki H, Beppu S, Nishikawa D, Terada H, Sawabe M, Hanai N. Lymph Node Ratio in Head and Neck Cancer with Submental Flap Reconstruction. Biomedicines 2022; 10:biomedicines10112923. [PMID: 36428496 PMCID: PMC9687667 DOI: 10.3390/biomedicines10112923] [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] [Received: 10/17/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate the relationship between the lymph node ratio (LNR) and survival results of patients with head and neck squamous cell carcinoma (HNSCC) reconstructed by a submental artery flap (SMAF) to limit tumor size. This study retrospectively recruited 49 patients with HNSCC who underwent both primary resection and neck dissection with SMAF reconstruction. The LNR was the ratio of the number of metastatic lymph nodes to the sum number of examined lymph nodes. A LNR of 0.04 was the best cut-off value for HNSCC-specific death on receiver operating curve analysis. Patients with LNRs > 0.04 were univariately related to cancer-specific, disease-free, distant metastasis-free, and locoregional recurrence-free survival than those with LNRs ≤ 0.04 by log-rank test. In a Cox’s proportional hazards model with hazard ratio (HR) and 95% confidence interval (CI) adjusting for pathological stage, extranodal extension and or surgical margins, the LNR (>0.04/≤0.04) predicted multivariate shorter cancer-specific (HR = 9.24, 95% CI = 1.49−176), disease-free (HR = 3.44, 95% CI = 1.23−10.3), and distant metastasis-free (HR = 9.76, 95% CI = 1.57−187) survival. In conclusion, LNR for patients of HNSCC with SMAF reconstruction for limited tumor size was a prognostic factor for survival outcomes.
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Varghese BT. Fasciocutaneous Type Axial Pattern Local and Regional Flaps: Alternative to Free Flaps? Indian J Surg Oncol 2021; 12:648-651. [PMID: 34658599 DOI: 10.1007/s13193-021-01405-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022] Open
Abstract
Emerging usage of carefully harvested, pedicled, local and regional, skin, mucosal, and myomucosal island has a potential to save operating time and resources. Presented here are two such flaps which serves as work horses for moderate defects of the oral cavity, i.e. the islanded nasolabial and facial artery myomucosal flaps, and the technical considerations advocated by the author.
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Affiliation(s)
- Bipin T Varghese
- Head and Neck Surgery, Department of Surgical Services, Regional Cancer Centre, Thiruvananthapuram, 695011 India
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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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Setty CMLN, Konduru V, Tirkey AJ, Agrawal M, George P, J R. The submental flap – Outcomes and oncologic safety in head and neck reconstruction. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Singh A, Chopra A, Chaudhary S, Venkatasubramaniyan M, Joshi K, Agarwal M. Modified submental platysmal adipomyofascial flap: is it a reliable alternate reconstructive option for small- to mid-sized defects especially in male patients with oral/oropharyngeal cancer? Eur Arch Otorhinolaryngol 2020; 278:2559-2567. [PMID: 33037441 PMCID: PMC7546521 DOI: 10.1007/s00405-020-06415-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022]
Abstract
Purpose To introduce modified submental platysmal adipomyofascial flap as a new and viable hairless locoregional option for reconstruction of small- to mid-sized defects after ablative surgery in oral/oropharyngeal cancer patients keeping in mind the present pandemic situation. Methods An observational retrospective study was conducted using modified submental platysmal adipomyofascial flap as a locoregional reconstructive option for both intraoral and oropharyngeal defects in early-stage oral/oropharyngeal cancer patients, from Jan 2016 to May 2020 in a tertiary care hospital. All patients in this study were male and the overall flap outcome was evaluated with post-operative follow-up. Results Out of 18 patients, in 4 patients modified submental platysmal adipomyofascial flap was used as a combination of flaps for reconstruction. Six patients (33.33%) underwent adjuvant radiation therapy/radiation chemotherapy. The long-term functions (speech and swallowing) and cosmetic outcomes were good in the majority of the patients. One patient (5.55%) had pinhole oroantral fistula. No patient had any major flap failure. Conclusion Modified submental platysmal adipomyofascial flap can be considered as a good alternative in male patients for reconstruction of small- to mid-sized oral cavity/oropharyngeal defects post-resection, especially during the prevailing pandemic crisis. It is an oncologically safe procedure with the major advantage of providing a hairless flap for oral cavity, tonsillar and BOT resection defects with lesser donor site morbidity.
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Affiliation(s)
| | - Anshu Chopra
- Head and Neck Oncology, RGCIRC, Rohini, Delhi India
| | | | | | - Kiran Joshi
- Head and Neck Unit II, RGCIRC, Rohini, Delhi India
| | - Mudit Agarwal
- Head and Neck Surgical Oncology, RGCIRC, Rohini, Delhi India
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Pradhan SA, Kannan R, Tiwari N, Jain S, Khan S, Rodrigues D, Doctor A, Jatale RG, Agrawal K, Shaikh M. Submental flap: Game changer in oral cancer reconstruction-A study of 1169 cases. J Surg Oncol 2020; 122:639-645. [PMID: 32700353 DOI: 10.1002/jso.26125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/07/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Free-flap reconstructions (FFRs) are the standard-of-care following resections for oral cancer. This study assessed an alternative, the pedicled submental flap (SF) for its versatility, oncological outcomes, and comparative operative time and cost. METHODS This was a longitudinal prospective study of 1169 patients of oral cancer reconstructed with the SF. Oncological outcomes in terms of recurrence rate and disease-free survival (DFS), were analyzed in 730 cases with a minimum of 18 months follow-up. Surgical time and cost were compared between 20 SFs and 14 FFRs performed consecutively. RESULTS SF was used to reconstruct defects in the cheek (29.2%), mandible (41.6%), tongue (26.3%) and palate (2.7%) with a 94% flap survival. N+ at level 1 did not adversely affect the recurrence rate as compared with N+ at levels other than level 1 (27.52% vs 29.81%). SFs took a shorter time (186 minutes vs 474 minutes) and cost significantly less than FFRs (P < .0001). CONCLUSIONS SF can reconstruct various oral defects, is sturdy, and esthetically and functionally satisfactory. The procedure time is much shorter than for FFR and costs considerably less. With careful case selection and meticulous clearance, SF reconstruction is oncologically safe even in N+ neck.
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Affiliation(s)
- Sultan A Pradhan
- Department of Surgical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Rajan Kannan
- Department of Surgical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Neelesh Tiwari
- Head and Neck Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Saurabh Jain
- Department of Surgical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Sana Khan
- Head and Neck Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Dale Rodrigues
- Department of Surgical Oncology, P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
| | - Azmat Doctor
- Department of Surgical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Raj G Jatale
- Biostatistician, Research Department, P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
| | - Kushal Agrawal
- Department of Surgical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Mohsin Shaikh
- Head and Neck Oncology, Prince Aly Khan Hospital, Mumbai, India
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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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Gileva KS, Ivanova ED. [Reverse perforator submental flap for closing soft tissue defects]. STOMATOLOGII︠A︡ 2020; 99:41-46. [PMID: 32608948 DOI: 10.17116/stomat20209903141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article presents the clinical results of using a new surgical method, involving the reverse perforator submental flap for reconstruction of soft tissue defects in the maxillofacial area in 5 patients aged from 41 to 62 years. The purpose of the study was to expand the indications for the use of the submental flap. A feature of the method is the sampling of a primary thin perforator submental flap with reverse blood flow with a minimal risk of postoperative complications. An algorithm for surgical flap taking has been developed. The study proves the safety and efficiency of the proposed method.
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Affiliation(s)
- K S Gileva
- National Medical Research Center of Dentistry and Maxillofacial Surgery of Ministry of Health of the Russian Federation, Moscow, Russia
| | - E D Ivanova
- National Medical Research Center of Dentistry and Maxillofacial Surgery of Ministry of Health of the Russian Federation, Moscow, Russia
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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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Tang L, Day AT, Lee R, Gordin E, Emerick K, Patel UA, Deschler DG, Richmon JD. Submental flap practice patterns and perceived outcomes: A survey of 212 AHNS surgeons. Am J Otolaryngol 2020; 41:102291. [PMID: 31732308 DOI: 10.1016/j.amjoto.2019.102291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To describe American Head and Neck Society (AHNS) surgeon submental flap (SMF) practice patterns and to evaluate variables associated with SMF complications. METHODS The design is a cross-sectional study. An online survey was distributed to 782 AHNS surgeons between 11/11/16 and 12/31/16. Surgeon demographics, training, practice patterns and techniques were characterized and evaluated for associations with frequency of SMF complications. RESULTS Among 212 AHNS surgeons, 108 (50.9%) reported performing SMFs, of whom 86 provided complete responses. Most surgeons who performed the SMF routinely reconstructed oral cavity defects with the flap (86.1%, n = 74). Thirty-seven surgeons (43.0%) experienced "very few" complications with the SMF. Surgeons who practiced in the United States versus internationally (p = 0.003), performed more total career SMFs (p = 0.02), and routinely reconstructed parotid and oropharyngeal defects (p = 0.04 and p < 0.001) with SMFs were more frequently perceived to have "very few" complications. SMF surgeons reported more perceived complications with the SMF compared to pectoralis major (p = 0.001) and radial forearm free flaps (p = 0.01). However, similar perceived complications were reported between all three flaps when surgeons performed >30 SMF. Among 94 surgeons not performing SMFs, 71.3% had interest in a SMF training course. CONCLUSIONS Practice patterns of surgeons performing SMFs are diverse, although most use the flap for oral cavity reconstruction. While 43% of surgeons performing the SMF reported "very few" complications, overall complication rates with the SMF were higher compared to other flaps, potentially due to limited experience with the SMF. Increased training opportunities in SMF harvest and inset are indicated.
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Chang BA, Asarkar AA, Nathan CO. What is the oncologic safety of using the submental flap to reconstruct oral cavity cancer defects? Laryngoscope 2019; 129:2443-2444. [DOI: 10.1002/lary.28193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 06/24/2019] [Accepted: 07/02/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Brent A. Chang
- Department of Otolaryngology/Head and Neck SurgeryLouisiana State University Health Sciences Center and Feist‐Weiller Cancer Center Shreveport Louisiana U.S.A
| | - Ameya A. Asarkar
- Department of Otolaryngology/Head and Neck SurgeryLouisiana State University Health Sciences Center and Feist‐Weiller Cancer Center Shreveport Louisiana U.S.A
- Department of SurgeryOverton Brooks Veterans Affairs Medical Center Shreveport Louisiana U.S.A
| | - Cherie‐Ann O. Nathan
- Department of Otolaryngology/Head and Neck SurgeryLouisiana State University Health Sciences Center and Feist‐Weiller Cancer Center Shreveport Louisiana U.S.A
- Department of SurgeryOverton Brooks Veterans Affairs Medical Center Shreveport Louisiana U.S.A
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Abstract
OBJECTIVES In recent years, the submental island flap has demonstrated decreased cost and morbidity as compared with free tissue transfer and has been widely applied to a range of head and neck defects. Several studies, however, continue to report a high rate of submental flap complications including partial necrosis and venous congestion. The object of this report is to describe a technical modification to the submental flap harvest which increases efficiency and reliability. METHODS Single institutional case series with chart review. The essential technical details and technique modifications of the submental flap harvest are described, and a case example is discussed. RESULTS Between January 2018 through January 2019, 24 submental island flaps were performed. All flaps included the mylohyoid muscle which was delineated with manual blunt dissection. Reconstructive indications included oral cavity and oropharyngeal wounds as well as facial cutaneous and lateral skullbase defects. There were no flap-related complications. CONCLUSIONS Manual blunt dissection of the mylohyoid muscle and its inclusion in the submental island flap increases efficiency and reliability.
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Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, USA
| | - Kevin S Emerick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, BA, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, BA, USA
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22
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Cariati P, Cabello Serrano A, Marin Fernandez A, Perez de Perceval Tara M, Juliá M, Ildefonso Martinez Lara M. Is submental flap safe for the oncological reconstruction of the oral cavity? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:284-287. [DOI: 10.1016/j.jormas.2018.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/17/2018] [Indexed: 11/15/2022]
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23
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Kang SY, Eskander A, Patel K, Teknos TN, Old MO. The unique and valuable soft tissue free flap in head and neck reconstruction: Lateral arm. Oral Oncol 2018; 82:100-107. [DOI: 10.1016/j.oraloncology.2018.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/07/2018] [Accepted: 05/12/2018] [Indexed: 11/25/2022]
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Aslam-Pervez N, Caldroney SJ, Isaiah A, Lubek JE. A Retrospective Volume Matched Analysis of the Submental Artery Island Pedicled Flap as Compared to the Forearm Free Flap: Is It a Good Alternative Choice for the Reconstruction of Defects of the Oral Cavity and Oropharynx? J Oral Maxillofac Surg 2018; 76:656-663. [DOI: 10.1016/j.joms.2017.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/06/2017] [Accepted: 08/06/2017] [Indexed: 10/19/2022]
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