Complications of the Submental Flap when used for Post-Oncological Oral Cavity Reconstruction

Abstract

Background: The oral cavity consists of the oral vestibule and oral cavity proper. Its primary function is to serve as the alimentary tract entrance and initiate the digestive process. It also serves as a secondary respiratory conduit, a site of sound modification to produce speech, and a chemosensory organ. The development of a primary malignancy within the oral cavity and subsequent cancer treatment and next cancer treatment can affect these standard functions. Aim of study:This work aims to discuss the complications of the submental island flap when used instead of the microvascular free flap in post- oncological oral cavity reconstruction. Subjects and Methods: An interventional study involved patients with carcinoma of the oral cavity doing submental island flap during the study period. Evaluation of the patient pre operatively by assessment of intraoral cancer stage (TNM), type of pathology degree of differentiation (grade), the neck flaps, and the submental flap dimensions by pinch test and using a ruler and comparing it with defect that will created after resection of intra oral tumor. All patients underwent one-stage procedure for tumor resection, neck lymph node dissection and reconstruction with orthograde contralateral or ipsilateral submental island flap. Results:79.16 % of the participants were intact regarding flap vascularity,3.8%were congested and conservatively managed, while12.5% were dead. Concerning the fate of totally dead, 33.33% were primary closed, 33.33% pectoralis major flap done to them, and 33.33% Thoracodorsal artery perforator flap (TDAP) was used. The Mean ± SD of hospital stay was 8.16 ± 3.17 days. 91.7 % of the patients did not need a tracheostomy, and 4.2% needed tracheostomy; only 8.3 % of them had infected wounds, and all of them preserved.Marginal Mandibular Nerve (MMN). 16.7 % of the participants had local recurrence, 8.3% of them had a nodular recurrence. 58.3% of the patients didn't need adjuvant therapy. Conclusion:Submental artery flap is a valid option for the reconstruction of oral cavity defects. It represents an excellent alternative to free flaps, particularly in elderly patients or in high-ASA risk in spite there are many complications, like flap vascularity impairment and the need for tracheostomy wound infection and early recurrence.