The adequacy of lymph node harvest in concomitant neck block dissection and submental island flap reconstruction for oral squamous cell carcinoma; a case series from a single Egyptian institution

BMC Oral Health

Osama Hussein¹  Fayez Shahatto¹  Sameh Roshdy¹  Islam A. Elzahaby¹ 

[1] Mansoura University cancer Center, Mansoura University, Mansoura 35516, Egypt

关键词: Submental flap;    Neck block dissection;    Oral squamous cell carcinoma;   

Others  :  1219304
DOI  :  10.1186/s12903-015-0064-0

 received in 2014-11-03, accepted in 2015-07-02,  发布年份 2015

【 摘 要 】

Background

Squamous cell carcinoma (SCC) is a fairly common tumor of the oral cavity. This tumor may affect any part of the mucosa of the oral cavity especially the tongue, the floor of the mouth and lips. The encountered intra-oral defects after tumor resection are often large and require climbing up the reconstruction ladder to more complex reconstructive options for accepted functional and cosmetic results to be achieved. However, most of the patients are old with medical co-morbidities requiring fast, simple, less morbid reconstructive option such as local flaps. The myocutaneous submental island flap has emerged as a simple and fast reconstructive technique that provides thin, pliable tissue with adequate volume and reliable blood supply. However, one major concern regarding the utility of the submental flap for repair of post-ablative tumor defects is the presumed interference with adequate lymph node neck dissection.

Methods

In this study, we present a cohort of thirty-six consecutive patients who were operated for oral SCC. All patients were offered submental island flap reconstruction of their resultant defects together with ipsilateral selective neck block dissection of levels I, II, III and IV; and the nodal yield of each level was tested pathologically.

Results

Nodal harvest was ≥12 in 88 % of the patients. Complications were encountered in two patients (5.5 %).

Conclusion

Our data suggest that adequate cervical lymph nodes dissection, specifically level I and II cervical lymph nodes, can be fulfilled with concomitant submental island flap elevation.

【 授权许可】

   
2015 Elzahaby et al.

【 图 表 】

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【 参考文献 】

• [1]El-Mofty S. Early detection of oral cancer. Egypt J Oral Maxillofac Surg. 2010; 1:25-31.
• [2]Martin T& Webster K. Lip and oral cavity. In Watkinson JC& Gilbert RW, eds . Stell & Maran ‘s Textbook of head and neck surgery and oncology. Hodder Arnold, London. 5th edition. 2012. Vol 1, page 549,
• [3]Sebastian P, Thomas S, Varghese BT, Iype EM, Balagopal PG, Mathew PC. The submental island flap for reconstruction of intraoral defects in oral cancer patients. Oral Oncol. 2008; 44(11):1014-8.
• [4]Blot WJ, Mclaughlin JK, Winn DM, Austin DF, Greenberg RS, Preston-Martin S, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res. 1988;48:3282–7.
• [5]Kim JT, Kim SK, Koshima I, Moriguchi T. An anatomic study and clinical applications of the reversed submental perforator- based island flap. Plast Reconstr Surg. 2002;109:2204–10.
• [6]Geden EM, Buchbinder D, Urken ML. The submental island flap for palatal reconstruction: A novel technique. J Oral Maxillofac Surg. 2004; 62:387-90.
• [7]Parmar PS, Goldstein DP. The submental island flap in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2009; 17(4):263-6.
• [8]Cinar C, Ogur S, Arslan H, Kilic A. Adding versatility to the reconstruction of intraoral lining: opened pocket method. J Craniofac Surg. 2007; 18(1):198-202.
• [9]Valentini V, Saltarel A, Cassoni A, Battisti A, Egidi S. One-stage reconstruction of a defect of the oral commissure and of the cheek with a radial forearm free flap. J CraniofacSurg. 2008; 19(6):1508-11.
• [10]Paydarfar JA, Patel UA. Submental island pedicled flap vs radial for arm free flap for oral reconstruction: comparison of outcomes. Arch Otolaryngol Head Neck Surg. 2011; 137:82-7.
• [11]Patel UA, Bayles SW, Hayden RE. The submental flap: a modified technique for resident training. Laryngoscope. 2007; 117:186-9.
• [12]Chavan KT, Reddy BP, Desai R, Manjunath S, Shubhalakshmi S, Umashankar KV. Versatility of pectoralis major myocutaneous flap. Int J Oral Maxillofac Surg. 2007; 36(11):1055.
• [13]McLean JN, Carlson GW, Losken A. The pectoralis major myocutaneous flap revisited: a reliable technique for head and neck reconstruction. Ann Plast Surg. 2010; 64(5):570-3.
• [14]Mehrhof AL, Rosenstock A, Neifeld JP, Merritt WH, Theogaraj SD, Cohen IK. The pectoralis major myocutaneous flap in head and neck reconstruction: an analysis of complications. Am J Surg. 1983;146:478.
• [15]El-Marakby HH. The reliability of pectoralis major myocutaneous flap in head and neck reconstruction. J Egypt Natl Canc Inst. 2006; 18(1):41-50.
• [16]Tassinari J, Orlandino G, Fabrizio T, Calabrese L. Submental flap in facial reconstructive surgery: Long-term casuistry revision. Plast Reconstr Surg. 2010; 126:139-40e.
• [17]Michael R& Glyn J. Submental flap. In Nahai & Mathes reconstructive surgery. quality medical publishing Inc. Italy. 2012..volume 1, section 5I. P 388–403.
• [18]Chen WL, Li JS, Yang ZH, Huang ZQ, Wang JU, Zhang B. Two submental island flaps for reconstructing oral and maxillofacial defects following cancer ablation. J Oral Maxillofac Surg. 2008; 66(6):1145-56.
• [19]Higgins KM, Backstein R. The submental island flap: a regional and a free flap with a myriad of reconstructive applications. J Otolaryngol. 2007; 36:88-92.
• [20]Chen WL, Ye JT, Yang ZH, Huang ZQ, Zhang DM, Wang K. Reverse facial artery-submental artery mandibular osteomuscular flap for the reconstruction of maxillary defects following the removal of benign tumors. Head Neck. 2009; 31:725-31.
• [21]Xuwei D, Jian X, Xueqin L, Xianjie Z, Jianbo Y, Wei L et al.. The Reconstruction of head and neck defects with the submental island flap. Head Neck Oncol. 2013; 5(2):19.
• [22]Amin AA, Sakkary MA, Khalil AA, Rifaat MA, Zayed SB. The submental flap for oral cavity reconstruction: extended indications and technical refinements. Head Neck Oncol. 2011; 3:51. BioMed Central Full Text
• [23]Howard BE, Nagel TH, Donald CB, Hinni ML, Hayden RE. Oncologic safety of the submental flap for reconstruction in oral cavity malignancies. Otolaryngol Head Neck Surg. 2013; 149 ( 2 )suppl:40.
• [24]Edge S, Byrd D, Compton C, Fritz A, Greene F & Trotti A (Editors). Lip and Oral Cavity American Joint Cancer Committee (AJCC) staging Manual, 7th edition, Springer-Verlag NewYork. 2010: p. 31.
• [25]Friedman M, Lim JW, Dickey W, Tanyeri H, Kirshenbaum GL, Phadke DM et al.. Quantification of lymph nodes in selective neck dissection. Laryngoscope. 1999; 109(3):368-70.
• [26]Pfister DG, Spencer S, Brizel DM, Burtness B, Busse PM, Caudell JJ et al.. Head and neck cancers, Version 2.2014. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2014; 12(10):1454-87.
• [27]Hamoir M, Schmitz S, Gregoire V. The role of neck dissection in squamous cell carcinoma of the head and neck. Curr Treat Options Oncol. 2014; 15(4):611-24.