Its utility in reconstruction following ablative head and neck procedures has been applied to various subsites including skin, lip, buccal mucosa, retromolar trigone, parotidectomy defects, and tongue. Submental artery island flap in reconstruction of hard. The submental island flap sif is a pedicled flap based upon the submental artery and vein. Class 2a defects in 5 patients were repaired with a reverse facial artery submental artery mandibular osteomuscular. The facialsubmental artery island flaps and vy advancement flaps survived in 93. The size of the facialsubmental artery island flap ranged from 3. Submental flap for reconstructing tongue defect with vy. Blood supply of this flap can be retrograded based on facial artery or reverse flow based on angular artery 4,5. A 63yearold male underwent submental artery perforator transposition flap for reconstruction of 4 x 3. Submental versus platysma flap for the reconstruction of complex facial defects following resection of head and neck tumors. In addition, it provides excellent colour and texture, great versatility and little morbidity in the donor site. Figure 6 a a 22yearold male presented with a left foot degloving injury with. The hybrid submental flap for tongue reconstruction todd c.
Department of otolaryngologyhead and neck surgery, the toronto hospital, university of toronto, toronto, ontario, canada. Our patient showed a very high level of mandibular destruction resistant to all mandibular sparing treatment strategies requiring segmental mandibulectomy and complex. Submental artery island flap smif is gaining popularity as a viable alternative to free flaps in carefully selected oral cavity defects after surgical extirpation of cancers. The submental island flap is an axial patterned flap based on the submental artery. Reconstruction of the lip commissure with upper and lower. Table 2 shows various modifications of this flap 710. Submental artery island flap smif has gained acceptance as a simple and reliable option in oral reconstruction. Infantile myofibromatosis is the most common benign fibrous tumor in infants. The submental island flap was harvested figure 5, based on the submental branch of the ipsi. Submental artery island flap in intraoral reconstruction. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. Vascular anatomy is a determining factor of successful. Submental flap in reconstruction of orofacial defects. The vascular anatomy of submental flaps sfs represents a determining factor in successful sf raising.
Submental perforator flap reconstruction of a malignant. This clinical study assessed the reverse facial arterysubmental artery mandibular osteomuscular. Submental artery island flap with simultaneous level i neck dissection. The submental artery flap is a reliable source of skin of excellent color, contour, and texture match for facial resurfacing. It arises deep to the submandibular gland and may be deep 70% or superficial 30% ref 8a to the digastric muscle. However, its role in composite defects involving the jaw is not clearly defined. Superficial head and neck vessels are increasingly used in surgical procedures and are especially important in facial transplantation surgeries. Treatment of eccrine carcinoma of the chin via submental. To obtain a thinner, more pliable flap and get a better oncological result, the submental artery perforator flap has been proposed, and to assess its feasibility for closure of defects after resection of cancers of the oral cavity we studied 20 patients, each of whom was treated in this way. Anatomic study of the vasculature of the submental artery flap. The size of the submental island flap varies greatly and is maximized at 18 cm. In this article, the authors present their experience with this flap for defects of the upper aerodigestive tract.
This flap may be used for the coverage of perioral, intraoral, and other facial defects, leaving a relatively acceptable donorsite scar. However, little attention has been focused on the venous return of sfs. Indeed, controversy exists about the flaps interference with an oncologically sound neck dissection a total of 21 patients with oral cavity cancers over a three year period were. Request pdf submental artery island flap in intraoral reconstruction. Surgical anatomy of the medial sural artery perforator flap wong et al. The submental island flap in head and neck cancer faisal m. Submental artery island flap versus free flap reconstruction of lateral facial soft tissue and parotidectomy defects.
The nasolabial flap was rotated medially for reconstruction of the upper lip and then folded upon itself to form the inner and outer aspects of the upper lip. Infantile myofibromatosis treated by mandibulectomy and. However, there are unsettled concerns regarding its safety in oral cancer because of insufficient data in the literature. The submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. Submental artery island flap can be used as a pedicle or free flap. The sa branches out from the facial artery at the level of superior edge of the submandibular gland. The submental artery flap has rekindled interest in using cervical flaps for reconstruction of head and neck defects. The submental island flap is supplied by the submental artery, a branch of the facial artery. The hybrid submental flap for tongue reconstruction. For this reason, the anatomy of the submental region and the submental artery sa has gained in importance recently. The submental island flap is a viable reconstructive. Submental artery island flap can be used as a pedicle or free flap 3. In this study, the submental region of formalinfixed cadavers was diss.
Reconstruction of intraoral defects after resection of. Submental island pedicled flap vs radial forearm free flap. This is a retrospective study of 21 patients who underwent upper aerodigestive tract reconstruction with submental artery flaps from. To analyse the the oncological safety of smifin oral reconstruction and to study the. We report a variant course of the submental vein observed during a dissection of a 79yearoldmale embalmed cadaver. The conventional submental island flap is raised based on the digastric muscle belly.
Submental artery island flap was first described by martin et al. The aim of this study was to compare noncontrastenhanced 3d phase contrast magnetic resonance angiography 3d pcmra and conventional intravenous administration of contrast media, i. Submental artery definition of submental artery by. Treatment of eccrine carcinoma of the chin via submental island flap ef.
The submental island flap is a common choice for reconstruction of intraoral defects. Submental artery islandsubmental artery island flapflap department of oral and maxillofacial surgery vinnitsa national medical university presentation by, patrick royson albertina sheehama supervised by. The sa runs anteromedially below the mandible and superficial. Elevation of the flap using a perforator pedicle without the use of muscle has been reported, and the submental perforator was demonstrated as being reliable.
Pedicled flap in lingual cancer reconstruction 14377 int j clin exp med 2016. A case of upper lip and moustache reconstruction using a submental artery perforator smap flap. The submental flap can be raised as fasciocutaneous, myocutaneous, osteomuscular and even with inclusion of the ipsilateral submandibular gland, these structural variants add to the versatility of. The skin characteristics make the submental region an available flap site for facial and intraoral reconstructions. The submental artery flap was first described by martin et al 7 in 1993. Noncontrastenhanced magnetic resonance angiography of. Submental artery definition of submental artery by the. The earliest reported use of this flap for reconstruction in oral carcinoma was by sterne and hall 8 in 1996. Original article the submental island flap in lingual.
Submental island flap versus free flap reconstruction for. Three different types have been reported in the literature. Submental flap for soft tissue reconstruction following. Since it was described, the flap has been extensively used for reconstruction of small. This versatile flap was successfully used for various defects in 19 patients and all flaps have survived with a few minor complications. The submental artery is a consistent branch of the facial artery. The submental artery is the largest of the cervical branches of the facial artery, given off just as that vessel leaves the submandibular gland. Reconstruction of the upper aerodigestive tract with the. Thus, the present study aimed to investigate sf venous return. This study enrolled patients who underwent sf reconstructive surgery in a tertiary referral center between november 2009 and october 2016. Surgical anatomy of the medial sural artery perforator flap. The adequacy of lymph node harvest in concomitant neck. The size of the vy advancement flaps ranged from 3. Pdf a case of upper lip and moustache reconstruction.
In this paper, simultaneous reconstruction of the upper lip and moustache is described. A submental flap was harvested in fashion described my previous authors. The submental artery island flap is a versatile option in head and neck reconstruction. The submental artery island flap is a type c fasciocutaneous flap with its dominant pedicle based on the submental artery, which arises approximately 56. Maxillary functional reconstruction using a reverse facial. Applied anatomy of the submental island flap and its. The submental artery island flap involves a relatively simple dissection, decreasing operative time, and avoiding microsurgical free tissue transfer.
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