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Xiao R, Yang Y, Feng Z, Han Z. Reverse submandibular gland flap: An alternative for reconstruction of medium-sized oral defects. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101579. [PMID: 37532080 DOI: 10.1016/j.jormas.2023.101579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/30/2023] [Indexed: 08/04/2023]
Abstract
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.
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Affiliation(s)
- Ranran Xiao
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, No. 4 Tian Tan Xi Li, Dongcheng District, Beijing 100050, PR China
| | - Yang Yang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, No. 4 Tian Tan Xi Li, Dongcheng District, Beijing 100050, PR China
| | - Zhien Feng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, No. 4 Tian Tan Xi Li, Dongcheng District, Beijing 100050, PR China.
| | - Zhengxue Han
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, No. 4 Tian Tan Xi Li, Dongcheng District, Beijing 100050, PR China.
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Zander DA, Gursahaney DL, Oliver C, Callen AL, Potigailo VL. CT and MR Imaging Appearance of the Pedicled Submandibular Gland Flap: A Potential Imaging Pitfall in the Posttreatment Head and Neck. AJNR Am J Neuroradiol 2023; 44:481-485. [PMID: 36927762 PMCID: PMC10084900 DOI: 10.3174/ajnr.a7825] [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: 06/11/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023]
Abstract
Pedicled locoregional submandibular gland reconstruction flaps are increasingly used in oncologic head and neck surgery and have unique imaging characteristics that can mimic locally recurrent tumor. In this clinical report, 23 posttreatment imaging studies were evaluated in 19 patients who had undergone submandibular gland flap reconstructions after resection of a primary head and neck tumor. Submandibular gland flaps were most commonly mobilized into the parapharyngeal space or parotid bed, with others located inferior to the mandibular body and within marginal mandibulectomy defects. The original shape of the gland was typically not preserved. Identifying the submandibular gland hilum, vascular pedicle, glandular texture, and absence of submandibular gland in the orthotopic location was most useful in recognizing a flap. The interpreting radiologist must be familiar with the unique submandibular gland flap imaging characteristics to accurately differentiate normal postoperative appearance and recurrent tumor.
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Affiliation(s)
- D A Zander
- From the Departments of Radiology (D.A.Z., D.L.G., A.L.C., V.L.P.)
| | - D L Gursahaney
- From the Departments of Radiology (D.A.Z., D.L.G., A.L.C., V.L.P.)
| | - C Oliver
- Otolaryngology-Head and Neck Surgery (C.O.), University of Colorado School of Medicine, Aurora, Colorado
| | - A L Callen
- From the Departments of Radiology (D.A.Z., D.L.G., A.L.C., V.L.P.)
| | - V L Potigailo
- From the Departments of Radiology (D.A.Z., D.L.G., A.L.C., V.L.P.)
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Novel Local Chimeric Flap Based on Tunnelized Facial Artery Myomucosal Island Flap and Submandibular Gland Flap for Reconstructions After Oral Squamous Cell Carcinoma Surgery. J Craniofac Surg 2023; 34:76-82. [PMID: 36608097 PMCID: PMC9794126 DOI: 10.1097/scs.0000000000008862] [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: 02/01/2022] [Accepted: 06/15/2022] [Indexed: 12/31/2022] Open
Abstract
The reconstruction of oral tongue and floor of mouth defects after resections of squamous cell carcinoma is a challenging task in reconstructive surgery aiming for appropriate restoration of oral function and quality of life improvement. In this study, the authors introduce the innovative reconstruction technique of medium-sized defects consisting of tunnelized facial artery myomucosal island flap and submandibular gland flap as the local chimeric flap pedicled on facial vessels. A retrospective case series evaluation of 4 patients suffering from oral cavity cancer (stages III and IVa), who underwent transoral tumor excision with neck dissection and immediate reconstruction in the time period September 2020 to July 2021, was conducted. No flap losses or flap-related complications were identified. No recurrences occurred during the follow-up at 11.0±4.5 months (range: 6-16 mo, median=11 mo). Tunnelized facial artery myomucosal island flap and submandibular gland flap local chimeric flap expands the reconstruction options of medium-sized defects after ablative oral cancer surgery in carefully selected patients primarily not suitable for free flap reconstructions.
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Skull Base Vagal Schwannoma. J Craniofac Surg 2021; 32:e670-e672. [PMID: 34705371 DOI: 10.1097/scs.0000000000007850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Skull base vagal nerve schwannoma (VNS) is relatively uncommon and poses a challenge to surgeons. Although schwannomas are benign and slowly growing neoplasms arising from Schwann cells, they may cause significant dysfunction by causing the surrounding structures compression or infiltrating vital structures such as the skull base, the orbit, and the cranial nerves. These tumors are resistant to radiotherapy and chemotherapy. Complete surgical removal is the optimal treatment modality, with recurrence being rare. The authors report a case of a 58-year-old man with an extensive VNS involving the left jugular foramen and parapharyngeal space. The clinical presentation, surgical management, and outcomes of VNS are discussed.
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Sublingual Gland and Mylohyoid Muscle Advancement: A Novel Combined Local Soft Tissue Reconstruction. J Craniofac Surg 2021; 32:e165-e167. [PMID: 33705061 DOI: 10.1097/scs.0000000000006954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Here the authors present the surgical management of a 78-year-old female with a superficial squamous cell carcinoma of the mucosa overlying her edentulous mandibular alveolus with no evidence of bony invasion.Combining the superficial nature of the lesion, patient age and substantial medical comorbidities, a limited intra-oral resection was planned, to avoid the need for free flap reconstruction. The operation required a wide local excision with clear clinical margins and a mandibular rim resection.All of the currently available reconstructions would result in prolonged surgical time, donor site morbidity, and possible secondary procedures. To overcome these pitfalls, a sublingual gland and mylohyoid muscle advancement flap was designed and executed. By combining the mylohyoid muscle and sublingual gland tissue as an advancement flap in a tension-free manner, secured to the remaining circumferential mucosa, a watertight closure was achieved.After an uneventful recovery without complication the patient was discharged the following day. Complete epithelialization was observed on day 25. Adjuvant radiotherapy was offered to reduce the risk of recurrence and progression. To date, no bony exposure and no pathological fractures have occurred.In conclusion, the entire procedure is simple and innovative. There is minimal donor site morbidity, with an immediate return to oral diet and tolerable surgical risks. It requires a small amount of surgical time compared to other reconstructive options and an overall reduced inpatient stay.
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Garcia-Serrano G, Moñux A, Maranillo E, Simon C, Sanudo JR, Vázquez MT, Acero J. Vascular clinical anatomy of the submandibular gland. J Craniomaxillofac Surg 2020; 48:582-589. [PMID: 32389551 DOI: 10.1016/j.jcms.2020.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/08/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim of this study is to describe in depth the precise anatomy of the vascular supply of the submandibular gland, trying to determine the existence of patterns of glandular vascularization. Knowledge of these patterns could facilitate surgical management of the gland and the submandibular gland flap. MATERIAL AND METHODS Neck dissections of formaldehyde preserved human cadavers were performed. Submandibular and transmandibular approaches were used during the dissections. All the vascular branches found were registered and classified into 2groups: main or accessory branches. The anatomical data analyzed was: The diameter and length of the main and accessory branches, as well as the most important measurements of the submandibular gland flap pedicle. RESULTS 33 glands were dissected to study the arterial supply of the submandibular gland (17 right, 16 left; 17 males, 16 females) and 29 were dissected to study the venous supply (15 left, 14 right; 15 males,14 females). A total of 123 arterial branches were found reaching the 33 submandibular glands (47 main and 76 accessories) and 116 venous branches were found draining the 29 submandibular glands (47 main branches and 69 accessory branches). A constant main venous branch that ran parallel to the Wharton duct and drained in the sublingual vein was found in all of cases (Concomitant Wharton Duct Vein or CWDV). CONCLUSION The CWDV is a constant venous branch for the drainage of the gland and should be considered as venous pedicle during the dissection of submandibular gland flaps.
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Affiliation(s)
| | - Alfonso Moñux
- Department Head, Professor, Otorhinolaryngology Department, La Mancha General Hospital, Alcazar de San Juan, Ciudad Real, Spain
| | - Eva Maranillo
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Spain.
| | - Clara Simon
- Professor, Statistics and Operational Research, Rey Juan Carlos University, Madrid, Spain
| | - José Ramón Sanudo
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Spain
| | - María Teresa Vázquez
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Spain
| | - Julio Acero
- Department Head, Professor, Oral and Maxillofacial Surgery Department, Ramón y Cajal Hospital, Madrid, Spain
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Yang L, Wei J, Wang W, He M, Huang L, Su T. Use of a submandibular gland flap for closure of oral cutaneous fistula. Oral Oncol 2020; 104:104583. [PMID: 32008912 DOI: 10.1016/j.oraloncology.2020.104583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 11/16/2022]
Abstract
We reported a rare case of submandibular oral cutaneous fistula (OCF) in a 27-year-old female. A submandibular gland flap (SMGF) was prepared after fistula resection to fill the dead space under the mouth floor. Based on this case report and a literature review, we discussed the pathogenesis and treatment of OCF, and compared the differences between the SMGF and other types of flaps.
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Affiliation(s)
- Liudi Yang
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Juan Wei
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weiming Wang
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mi He
- Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Long Huang
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Tong Su
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Closure of Orocutaneous Fistula Using Submandibular Gland as a Pedicled Flap. Case Rep Dent 2019; 2019:3438626. [PMID: 30937195 PMCID: PMC6415282 DOI: 10.1155/2019/3438626] [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: 10/14/2018] [Accepted: 01/15/2019] [Indexed: 12/04/2022] Open
Abstract
Orocutaneous fistulas in the maxillofacial region may be due to tumor resection, osteoradionecrosis, or trauma, and these defects limit the function of the patients and effect aesthetic and also psychological condition. Articulation and nutrition are also affected by these fistulas. Local flaps can be used for the reconstruction of small- and medium-sized defects with ease. Submandibular gland with its rich blood supply from the facial artery is a practical and useful choice for the reconstruction of mandibular region defects.
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Eguchi T, Basugi A, Kanai I, Miyata Y, Hamada Y. Sublingual gland flap for soft tissue reconstruction of oral defects. Br J Oral Maxillofac Surg 2018; 56:895-896. [DOI: 10.1016/j.bjoms.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
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Chen J, Li W. [Research progress of pedicled flaps for defect repair and reconstruction after head and neck tumor resection]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:369-376. [PMID: 29806291 DOI: 10.7507/1002-1892.201710098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the current status of pedicled flaps for defect repair and reconstruction after head and neck tumor resection, and to present its application prospects. Methods Related literature was reviewed, and the role evolution of pedicled flaps in the reconstruction of head and neck defects were discussed. The advance, anatomical basis, indications, advantages, disadvantages, and modification of several frequently used pedicled flaps were summarized. Results The evolution of pedicled flaps application showed a resurgence trend in recent years. Some new pedicled flaps, e.g., submental artery island flap, supraclavicular artery island flap, submandibular gland flap, and facial artery musculomucosal flap, can acquire equivalent or even superior outcome to free flaps in certain cases. Technological modification of some traditional pedicled flaps, e.g., nasolabial flap, pectoralis major myocutaneous flap, latissimus dorsi musculocutaneous flap, temporalis myofascial flap, and temporoparietal fascial flap, can further broaden their indications. These traditional flaps still occupy an irreplaceable role, especially in patients with poor condition and institution with immature microsurgical techniques. Conclusion The pedicled flaps still plays an important role in head and neck reconstruction after tumor resection. In certain cases, they demonstrate some advantages over free flaps, e.g., more convenient harvest, more rapid recovery, less expenditure, and better functional and aesthetic effect.
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Affiliation(s)
- Jian Chen
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Wuhan Hubei, 430079, P.R.China
| | - Wei Li
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Wuhan Hubei, 430079,
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Oropharyngeal reconstruction with a pedicled submandibular gland flap. Br J Oral Maxillofac Surg 2015; 54:388-93. [PMID: 26388070 DOI: 10.1016/j.bjoms.2015.08.267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 08/29/2015] [Indexed: 11/20/2022]
Abstract
Locoregional flaps are widely used for reconstruction of small and medium defects in the oral cavity. The submandibular gland flap is a pedicled flap, which derives its blood supply from the facial artery, based on the submandibular gland. We describe the use of the flap in 20 patients who required oropharyngeal reconstruction with a pedicled submandibular gland flap after resection of a tumour between July 2012 and October 2014. Patients with squamous cell carcinoma were excluded. All flaps were pedicled on the facial vessels (inferiorly in 17 patients and superiorly in 3). The indications were: reconstruction of intraoral mucosal defects (n=13), filling the parapharyngeal dead space (n=6), and obliteration of the mastoid (n=1). All the flaps atrophied, but with no clinical effect. One patient developed partial loss of the flap, and one early leakage. There were no cases of xerostomia, and no signs of recurrence during the postoperative follow-up period of 3-26 months. The flap is useful, as it is simple and reliable for reconstruction of small to medium oropharyngeal defects in carefully selected cases, and gives good cosmetic and functional results.
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