Ear, Nose & Throat Journal2023, Vol. 102(3) 151–152© The Author(s) 2021Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/0145561320987039journals.sagepub.com/home/ear
Abstract
Gingival carcinoma is a common malignant tumor occurring in the anterior area of the mandible, which can be derived from the epithelium of gingival mucosa. Surgical extended resection is the main treatment of gingival cancer, which can lead to anterior mandibular defect including mouth floor and mandible and mucosa of lower lip. According to the size of the defect, the common repair method is free musculocutaneous flap with vascular pedicle or pedicle flap. We present a method of repairing mandibular anterior tooth defect with an island flap pedicled with the mental artery.
Keywordsisland flap, mouth floor, mental artery, reconstruction
Nasolabial flap and submental island flap pedicled with facial artery are common flaps for repairing small oral defect. However, both flaps require dissection of facial arteries in the submandibular region, and the technique is complex. The submental lymph node is the main site of anterior mandible drainage. Therefore, for the gingival cancer in the anterior part of the mandible, the submental flap pedicled with the facial artery has the risk of cancer cell metastasis. An island flap pedicled with mental artery to repair mandibular defect was reported in this article. The flap does not contain submental lymph nodes, which can avoid the risk of carrying metastatic cancer cells. The technique is simple in operation, reliable in blood supply, and suitable for the repair of mandibular defects.
This technique is suitable for anterior mandibular defects, and at least one of the mental arteries can be preserved after tumor resection. First, the tumor was enlarged and excised until pathological examination showed no residual tumor cells at the edge (as shown in Figure 1). Second, the shape and size of submental island flap were designed according to the defect. In order to prevent the submental flap including submental lymph nodes, the flap only includes skin, subcutaneous, and platysma. The periosteum of the mandible was removed from the deep platysma muscle laterally to the lower margin of the mandible, and the mandible foramen and mental artery were revealed by cutting along the mandible. Finally, the valvular artery is mentally centered with 0.5 to 1 cm of tissue (as shown in Figure 2). After confirming the good blood supply of the distal end of the flap, the flap with the mandible defect was then transferred forward and sutured, with negative pressure drainage (as shown in Figure 3), and the submental donor area was sutured directly. The flap survived completely and the wound healed in one stage after operation.
Nasolabial flap and submental island flap pedicled with facial artery are commonly used for reconstruction of small oral defects.1,2 However, both flaps require dissection of facial arteries in the submandibular region, and the technique is complex. The submental lymph node is the main site of anterior mandible drainage. Therefore, for the gingival cancer in the anterior part of the mandible, the submental flap based on the facial artery has the risk of cancer cell metastasis.3 Although the mental artery does not directly participate in the blood supply of the submental skin, there are abundant anastomosis networks among the mental artery, submental artery, and labial artery. Thus, the submental flap pedicled with the mental artery can completely satisfy the blood supply of the submental flap. In addition, the flap does not contain submental lymph nodes, which can avoid the risk of carrying metastatic cancer cells. The technique is simple in operation, reliable in blood supply, and suitable for the repair of mandibular defects.
Ruxiao Xing, Jingya He, Feng Wang, Bin Sun, and Wei Zhang participated in the conception and design of the research/review/case series. Ruxiao Xing, Jingya He, Feng Wang, and Jinzhong Liu were responsible for data acquisition: laboratory or clinical/library literature retrieval, and analysis and interpretation of collected data. Ruxiao Xing wrote articles. Bin Sun and Wei Zhang made critical modifications to the article and confirmed the manuscript as the guarantor. Ethical approval was not required. There are no pictures in which the patient is identifiable.
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The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Bin Sun https://orcid.org/0000-0002-8177-4053
1 School and Hospital of Stomatology, Jilin University, Changchun, China
Received: November 12, 2020; revised: December 13, 2020; accepted: December 18, 2020
Corresponding Authors:Bin Sun, PhD, and Wei Zhang, PhD, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Qinghua Road 1500, Changchun, Jilin 130000, China.Emails: sunbin06@sohucom; DentistZW@163.com
