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Program Number: B302
Session Name: Poster Session

The Submental Island Flap for Reconstruction of Maxillectomy Defects

Sarah C Nyirjesy, MD; Jeremy D Richmon, MD; Daniel G Deschler, MD, FACS; Mass Eye and Ear/Harvard Medical School

Importance: The hard palate and maxilla play important roles in speech, swallowing, and in separating the nasal cavity from the oral cavity. Even small tumors of the maxillary alveolus can result in oroantral fistulae, which decreases patient quality of life. While prosthodontic obturators offer a solution, they are often costly and have delays in oral rehabilitation. For these reasons, numerous reconstructive techniques, including free and local flaps, have been reported, but these may lead to significant morbidity, require tracheostomy placement, and may not provide adequate pedicle length or soft tissue size to reconstruct larger defects. We present the first case series of submental island flap reconstruction for palate and infrastructure maxillectomy defects, offering a promising alternative to free flaps.

Objective: Describe the use of the submental island flap for reconstruction for palate and infrastructure maxillectomy defects.

Methods: Using CPT codes, all surgical cases performed at our institution were identified for which a maxillectomy and submental flap reconstruction were performed. Data collected included patient demographics, tumor characteristics, intraoperative details, surgical duration, time to oral diet initiation, and need for tracheostomy.

Results: Among the 8 identified cases of maxillectomy with submental flap reconstruction: 6 patients were male and 2 female, with an average age of 78 years (range: 66-97 years). Primary tumor sites included the retromolar trigone (n=2), buccal mucosa (n=2), maxillary alveolus (n=2), hard palate (n=1), and soft palate (n=1). Most tumors were stage T4 due to bony involvement, with an average size of 3.4 cm in the largest dimension (range: 1.8-4.1cm). Neck dissections were performed in all cases, with 2 patients showing positive lymph nodes, no patients had positive level 1 lymph nodes. Submental flap sizes ranged from 4 x 6 cm to 6 x 9 cm. Average surgical time was 224 minutes (range: 187-253 minutes). Tracheostomy was not required for any patients. Seven of 8 patients achieved an oral diet, with time to oral nutrition ranging from postoperative days 3–7. One patient experienced significant complications. This patient had multiple medical comorbidities including a mechanical heart valve and end-stage renal disease, who suffered postoperative atrial fibrillation and recurrent bleeding, resulting in delayed adjuvant therapy and eventual tumor recurrence with the decision to proceed with hospice care.

Conclusion: The submental island flap is a viable and effective alternative for the reconstruction of palatal and maxillary defects, particularly in elderly patients. This case series demonstrates early return to oral intake, avoidance of tracheostomy, and relatively short operative times, making it a promising option for patients who may not be ideal candidates for more complex free flap procedures.

 

 

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