Versatility of Submental Island Flap in N0 Neck in Oral Malignancies- A Retrospective Analysis of 50 Cases

Submental flap is a gaining popularity as a reconstruction of orofacial defects in post-ablative defects, especially in situations where free flap services are not available or feasible. The background of this study was to demonstrate the oncological safety and benefits of this flap in oral cavity reconstruction. A retrospective analysis of 50 patients from the age group 28 to 70 years with oral cavity cancers of different subsites, who underwent submental flap reconstruction from 2018 to 2022 at our hospital for various ablative defects of oral cavity, were included in the study. We have reviewed the parameters like flap complications, post-operative mouth opening after 1 year and nodal recurrence. There were 37 males and 13 females patients in the study. 29(58%) patients had buccal cancers, 11(22%) patients had tongue cancer, 7(14%) patients had retromolar trigone cancer and 3(6%) had gingivo-buccal cancers. All patients underwent resection with ipsilateral selective neck dissection after flap was harvested. Complete flap loss was observed in 1(2%) patient, whereas as the flap dehiscence was seen in 3(6%) patients. Mean follow-up was 12 months. There were 3(6%) cases of nodal recurrence on the same side of flap after a mean time of 5 months of surgery. Inter-Incisal mouth opening was 20-30 mm in 68% of the cases. On the 1 year follow-up, all the patients were alive with no mortality. Oncologic outcome in terms of overall survival was found to be 94% in patients reconstructed with submental flap which makes it versatile for oral cavity reconstructions. Submental flap is a robust flap for oral cavity reconstruction. However, preoperative selection of clinically neck node-negative patient is extremely important as it has potential risk of occult metastasis and oncologic safety.