Combined submandibular gland flap and sternocleidomastoid musculocutaneous flap for postoperative reconstruction in older aged patients with oral cavity and oropharyngeal cancers

World Journal of Surgical Oncology

Shaojin Li¹  Keqing Luo³  Xiaolin Lan³  Folin Liu²  Xiangmin Zhang³ 

[1] Ganzhou Institute of Cancer Research, 19, HuaYuan Qian Road, Ganzhou 341000, Jiangxi Province, People’s Republic of China;First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, People’s Republic of China;Department of Head and Neck Surgery, Ganzhou Tumor Hospital, Ganzhou Jiangxi Province, People’s Republic of China

关键词: Reconstruction;    Oropharyngeal cancer;    Oral cavity cancer;    Sternocleidomastoid musculocutaneous flap;    Submandibular gland flap;   

Others  :  1148298
DOI  :  10.1186/1477-7819-12-259

 received in 2013-12-23, accepted in 2014-08-06,  发布年份 2014

【 摘 要 】

Background

The growth of aging populations in an increasing number of countries has led to a concomitant increase in the incidence of chronic diseases. Accordingly, the proportion of older aged patients with oral cavity and oropharyngeal cancers and comorbidities has also increased. Thus, improvements must be made in the tolerance and safety of surgical procedures for these patients with complex medical conditions. In this study, we investigated combined submandibular gland flap and sternocleidomastoid musculocutaneous flap for postoperative reconstruction in older aged patients with oral cavity and oropharyngeal cancers in terms of surgical methods, safety, and clinical outcome.

Methods

Between January 2011 and May 2012, 8 patients over the age of 65 years (7 men, 1 woman; aged 66 to 75 years (median, 69.6)) with oral cavity and oropharyngeal cancers underwent combined submandibular gland and sternocleidomastoid myocutaneous flaps for postoperative reconstruction at Ganzhou Tumor Hospital. All eight patients had comorbid cardiovascular, cerebrovascular, or chronic respiratory disease or diabetes. Clinical outcomes, complications, and tolerance to surgical treatment were observed.

Results

Surgical treatment was successful in all eight patients. All submandibular gland flaps survived with well-mucosalized surfaces and with no complications. During the postoperative follow-up period of 12 to 28 months, no patient developed local recurrence or distant metastasis, and all had good recovery of function and local contour.

Conclusions

This combined reconstruction technique enables appropriate restoration of oral function, facial aesthetics and improved quality of life. Further, this technique has several advantages: it is easier to perform, reduces operation time and surgical risk, causes less surgical injury, and has minor impact on contour. The technique provides a new and safe reconstruction option for older aged patients with oral cavity and oropharyngeal cancers.

【 授权许可】

   
2014 Zhang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Kubo T, Osaki Y, Hattori R, Kanazawa S, Hosokawa K: Reconstruction of through-and-through oromandibular defects by the double-skin paddle fibula osteocutaneous flap: can the skin paddle always be divided? J Plast Surg Hand Surg 2013, 47(1):46-49.
• [2]Rudes M, Bilić M, Jurlina M, Prgomet D: Pectoralis major myocutaneous flap in the reconstructive surgery of the head and neck - our experience. Coll Antropol 2012, 36(Suppl 2):137-142.
• [3]Stott-Miller M, Chen C, Chuang SC, Lee YC, Boccia S, Brenner H, Cadoni G, Dal Maso L, La Vecchia C, Lazarus P, Levi F, Matsuo K, Morgenstern H, Müller H, Muscat J, Olshan AF, Purdue MP, Serraino D, Vaughan TL, Zhang ZF, Boffetta P, Hashibe M, Schwartz SM: History of diabetes and risk of head and neck cancer: a pooled analysis from the international head and neck cancer epidemiology consortium. Cancer Epidemiol Biomarkers Prev 2012, 21(2):294-304.
• [4]Rouviere H, Tobies MJ: Trans: Anatomy of the Human Lymphatic System. 1st edition. Ann Arbor, MI: Edwards Brothers; 1938:86-88.
• [5]Haagensen CD: The Lymphatics in Cancer. 1st edition. Philadelphia, London, Toronto: Saunders WB; 1972:68-69.
• [6]DiNardo LJ: Lymphatics of the submandibular space: an anatomic, clinical, and pathologic study with applications to floor-of-mouth carcinoma. Laryngoscope 1998, 108(2):206-214.
• [7]Ebrahim AK, Loock JW, Afrogheh A, Hille J: Is it oncologically safe to leave the ipsilateral submandibular gland during neck dissection for head and neck squamous cell carcinoma? J Laryngol Otol 2011, 125(8):837-840.
• [8]Spiegel JH, Brys AK, Bhakti A, Singer ML: Metastasis to the submandibular gland in head and neck carcinomas. Head Neck 2004, 26(12):1064-1068.
• [9]Razfar A, Walvekar RR, Melkane A, Johnson JT, Myers EN: Incidence and patterns of regional metastasis in early oral squamous cell cancers: feasibility of submandibular gland preservation. Head Neck 2009, 31(12):1619-1623.
• [10]Chen TC, Lo WC, Ko JY, Lou PJ, Yang TL, Wang CP: Rare involvement of submandibular gland by oral squamous cell carcinoma. Head Neck 2009, 31(7):877-881.
• [11]Seikaly H, Jha N, Harris JR, Barnaby P, Liu R, Williams D, McGaw T, Rieger J, Wolfaardt J, Hanson J: Long-term outcomes of submandibular gland transfer for prevention of postradiation xerostomia. Arch Otolaryngol Head Neck Surg 2004, 130(8):956-961.
• [12]Geerling G, Honnicke K, Schröder C, Framme C, Sieg P, Lauer I, Pagel H, Kirschstein M, Seyfarth M, Marx AM, Laqua H: Quality of salivary tears following autologous submandibular gland transplantation for severe dry eye. Graefes Arch Chin Exp Ophthalmol 1999, 237(7):546-553.
• [13]Sinha UK, Ng M: Surgery of the salivary glands. Otolaryngol Clin North Am 1999, 32(5):887-906.
• [14]Rosti G, Callea A, Merendi R, Beccati D, Tienghi A, Turci D, Marangolo M: Metastases to submaxillary gland from breast cancer: case report. Tumori 1987, 73(4):413-416.
• [15]Junquera L, Albertos JM, Ascani G, Baladrón J, Vicente JC: Involvement of the submandibular region in epidermoid carcinoma of the mouth floor. Prospective study of 31 cases. Minerva Stomatol 2000, 49(11–12):521-525.
• [16]Basaran B, Ulusan M, Orhan KS, Gunes S, Suoglu Y: Is it necessary to remove submandibular glands in squamous cell carcinomas of the oral cavity? Acta Otorhinolaryngol Ital 2013, 33(2):88-92.
• [17]Vessecchia G, Di Palma S, Giardini R: Submandibular gland metastasis of breast carcinoma: a case report and review of the literature. Virchows Arch 1995, 427(3):349-351.
• [18]Byeon HK, Lim YC, Koo BS, Choi EC: Metastasis to the submandibular gland in oral cavity squamous cell carcinomas: pathologic analysis. Acta Otolaryngol 2009, 129(1):96-100.
• [19]Dhiwakar M, Ronen O, Malone J, Rao K, Bell S, Phillips R, Shevlin B, Robbins KT: Feasibility of submandibular gland preservation in neck dissection: a prospective anatomic-pathologic study. Head Neck 2011, 33(5):603-609.
• [20]Al-Qahtani K, Hier MP, Sultanum K, Black MJ: The role of submandibular salivary gland transfer in preventing xerostomia in the chemoradiotherapy patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006, 101(6):753-756.
• [21]Martin D, Pascal JF, Baudet J, Mondie JM, Farhat JB, Athoum A, Le Gaillard P, Peri G: The submental island flap: a new donor site anatomy and clinical applications as a free or pedicled flap. Plast Reconstr Surg 1993, 92(5):867-873.
• [22]Sterne GD, Januszkiewicz JS, Hall PN, Bardsley AF: The submental island flap. Br J Plast Surg 1996, 49(2):85-89.