Oral Kavite Tümörlerinde Submental Ada Flebi ile Rekonstrüksiyon: Güncel Yaklaşımda Avantajlar ve Dezavantajlar

Öz

Giriş: Oral kavite, baş boyun kanserlerinin en sık görüldüğü bölgedir. İlk basamak tedavisi cerrahi olan bu kanserlerin, rezeksiyonu sonrası oluşan defektlerin rekonstrüksiyonu karmaşık bir süreçtir. Bunun için altın standart yaklaşım mikrovasküler serbest fleptir. Bununla birlikte, uzun süreli cerrahiye uygun olmayan yaşlı, kötü beslenmesi olan, ek komorbit hastalıkları olan hastalarda pediküllü flep kullanımı değerli bir seçenek olmaya devam etmektedir. Tartışma: Submental ada flebi oral kavite rekonstrüksiyonlarında yaygın olarak kullanılmaktadır. Hastaların yutma ve konuşma fonksiyonları, genel ve lokal nüks oranları için serbest fleplerle submental ada flebi arasında anlamlı farklılık saptanmamıştır. Ayrıca submental ada flebi daha kısa ameliyat süresi, daha kısa hastanede kalış süresi ve dönor sahada daha az komplikasyon sayısı gibi önemli avantajlara sahiptir. Sonuç: Submental ada flebi özellikle mikrovasküler cerrahi için zayıf aday olan hastalarda tümör rezeksiyonu sonrası onkolojik sonuçlardan ödün vermeden oral kavite defektlerinin rekonstrüksiyonu için uygun bir seçenektir.

Anahtar Kelimeler

• Oral kavite tümörü
• submental ada flebi
• rekonstrüksiyon

Submental Island Flap Reconstruction in Oral Cavity Tumors: Advantages and Disadvantages in the Current Approach

Abstract

İntroduction: Reconstruction of defects emerged after resection of these cancers, whose first-line treatment is surgical, is a complex process. The gold standard approach for this is the microvascular free flap. However, the use of pedicle flap remains a valuable option in elderly patients who are not suitable for long-term surgery, have poor nutrition, and have additional comorbid diseases. Discussion: Submental island flap, is widely used in oral cavity reconstructions. There was no significant difference between free flaps and submental island flaps for swallowing and speech functions, general and local recurrence rates. In addition, submental island flap has important advantages such as shorter operation time, shorter hospital stay, and fewer complications in the donor area. Conclusion: Submental island flap is a suitable option for the reconstruction of oral cavity defects without compromising oncologic results after tumor resection, especially in patients who are poor candidates for microvascular surgery.

Keywords

• Oral cavity tumor
• submental island flap
• reconstruction

Kaynakça

1. 1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006;56(2):106-30.
2. 2. Kerawala C, Roques T, Jeannon JP, et al. Oral cavity and lip cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):83-9.
3. 3. Veness MJ, Morgan GJ, Sathiyaseelan Y, et al. Anterior tongue cancer and the incidence of cervical lymph node metastases with increasing tumour thickness: should elective treatment to the neck be standard practice in all patients? ANZ J Surg. 2005;75(3):101-5.
4. 4. Colletti G, Autelitano L, Tewfik K, et al. Autonomized flaps in secondary head and neck reconstructions. Acta Otorhinolaryngol Ital. 2012;32(5):329-35.
5. 5. Martin D, Pascal JF, Baudet J, et al. The submental island flap: a new donor site. Anatomy and clinical applications as a free or pedicled flap. Plast Reconstr Surg 1993;92(05):867–73
6. 6. Sterne GD, Januszkiewicz JS, Hall PN, et al. The submental island flap. Br J Plast Surg 1996;49(02):85–9.
7. 7. Cariati P, Cabello Serrano A, et al. Is submental flap safe for the oncological reconstruction of the oral cavity? J Stomatol Oral Maxillofac Surg 2018;119(04):284–7
8. 8. Faltaous AA, Yetman RJ. The submental artery flap: an anatomic study. Plast Reconstr Surg. 1996 Jan;97(1):56-60; discussion 61-2.

9. 9. Magden O, Edizer M, Tayfur V, et al. Anatomic study of the vasculature of the submental artery flap. Plast Reconstr Surg 2004;114:1719–23.
10. 10. Patel UA, Bayles SW, Hayden RE. The submental flap: a modified technique for resident training. Laryngoscope 2007;117:186–9.
11. 11. Huang L, Wang WM, Gao X, et al. Reconstruction of intraoral defects after resection of cancer with two types of submental artery perforator flaps. Br J Oral Maxillofac Surg 2018;56:34–8.
12. 12. Multinu A, Ferrari S, Bianchi B, et al. The submental island flap in head and neck reconstruction. Int J Oral Maxillofac Surg 2007;36:716–20.
13. 13. Vural E, Suen JY. The submental island flap in head and neck reconstruction. Head Neck 2000;22:572–8.
14. 14. Schonauer F, Di Martino A, Nele G, et al. Submental flap as an alternative to microsurgical flap in intraoral post-oncological reconstruction in the elderly. Int J Surg 2016;33:51–6.
15. 15. Howard BE, Nagel TH, Donald CB, et al. Oncologic safety of the submental flap for reconstruction in oral cavity malignancies. Otolaryngol Head Neck Surg 2013;149(2 Suppl):40.
16. 16. Tarsitano A, Vietti MV, Cipriani R, et al. Functional results of microvascular reconstruction after hemiglossectomy: free anterolateral thigh flap versus free forearm flap. Acta Otorhinolaryngol Ital 2013;33:374–9.
17. 17. Sittitrai P, Reunmakkaew D, Srivanitchapoom C. Submental island flap versus radial forearm free flap for oral tongue reconstruction: a comparison of complications and functional outcomes. J Laryngol Otol. 2019;133(5):413-8.
18. 18. Chow TL, Chan TT, Chow TK, et al. Reconstruction with submental flap for aggressive orofacial cancer. Plast Reconstr Surg 2007;120:431–6.
19. 19. Karmer FJ, Böhrnsen F, Moser N, et al. The submental island flap for the treatment of intraoral tumor-related defects: no effect on recurrence rates. Oral Oncol 2015;51:668–73.
20. 20. Patel UA. The submental flap for head and neck reconstruction: Comparison of outcomes to the radial forearm free flap. Laryngoscope. 2020;130 Suppl 2:1-10.
21. 21. Forner D, Phillips T, Rigby M, et al. Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction: a case series and cost analysis. J Otolaryngol Head Neck Surg 2016;45:11.
22. 22. Parmar PS, Goldstein DP. The submental island flap in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2009;17:263–6.
23. 23. Paydarfar JA, Patel UA. Submental island pedicled flap vs radial forearm free flap for oral reconstruction: comparison of outcomes. Arch Otolaryngol Head Neck Surg. 2011;137(1):82-7.
24. 24. Lee JC, Lai WS, Kao CH, et al. Multiple-parameter evaluation demonstrates low donor-site morbidity after submental flap harvesting. J Oral Maxillofac Surg. 2013;71(10):1800-8.
25. 25. Sittitrai P, Srivanitchapoom C, Reunmakkaew D, et al. Submental island flap reconstruction in oral cavity cancer patients with level I lymph node metastasis. Br J Oral Maxillofac Surg 2017;55:251–5.
26. 26. Hsiao HT, Leu YS, Liu CJ, et al. Radial forearm versus anterolateral thigh flap reconstruction after hemiglossectomy: functional assessment of swallowing and speech. J Reconstr Microsurg. 2008;24(2):85-8.