This article supplements the Operative Techniques video presentation, which can be viewed online on Head & Neck’shomepageat
Submental artery island flap with simultaneous level I neck
Antoine Eskander MD, ScM, FRCS(C)
Daniel Strigenz MD
Nolan Seim MD
Enver Ozer MD
Department of Otolaryngology - Head and
Neck Surgery, Division of Head and Neck
Oncology, Ohio State University, James
Cancer Centre and Solove Research
Institute, Columbus, Ohio
Enver Ozer, Department of
Otolaryngology, Head and Neck Surgery,
James Cancer Hospital and Solove
Research Institute, 456 West 10th
Avenue, Room #4a, Columbus, OH
Background: The purpose of this study was to illustrate the submental island flap
elevation technique with simultaneous level I neck dissection followed by the inset
and reconstruction of an oropharyngeal defect.
Methods: A 63-year-old patient with a T2N1M0 human papillomavirus-positive
squamous cell carcinoma of the tonsil was treated with concurrent chemoradiotherapy
(cisplatin 1 66 Gy). A local recurrence 2.5 years after treatment was treated surgically
and reconstructed with a submental island flap.
Results: There were no complications and oral diet was initiated at 2 weeks and the
gastrostomy tube was removed 1 month postoperatively. A video demonstration of
the submental island flap elevation is included with a focus on how levels 1A and 1B
can be dissected safely and this can be viewed online on Head & Neck’s home page
Conclusion: The submental island flap can be performed safely with a level I neck
dissection for head and neck reconstruction.
head and neck surgery, reconstructive surgery, regional flap
The submental flap, originally described my Martin et al
1993, was developed because of its good color and texture match
for facial defects with the added benefit of having a favorable
concealed donor site scar.
More recently, the flap was been
used for oral cavity and oropharyngeal mucosal defects. The
oncologic safety and adequacy of lymph node dissection has
been demonstrated by multiple groups.
The oncologic safety
is less of a concern in the management of oropharyngeal, laryn-
geal, and hypopharyngeal compared with oral cavity tumors.
The flap can be elevated with anterograde or retrograde
flow. The retrograde flow modification was developed to
provide an increased cephalad arc of rotation in the recon-
struction of the upper face and more distal defects.
ever, using an anterograde hybrid flap, where the pedicle
vein is divided and microvascularly anastomosed to a
closer venous drainage system, can increase the pedicle
length and arc of rotation by approximately 5 cm.
that patients with head and neck cancer are often elderly
with poor comorbidity profile, regional flaps are increas-
ingly being considered to provide simpler reconstructive
As an example, we chose 1 patient to demonstrate the tech-
nique. A 63-year-old patient with a T2N1M0 human
Antoine Eskander and Daniel Strigenz are co-first authors who contributed
equally to this work.
2018 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/hed Head & Neck. 2018;40:842–845.
Received: 13 June 2017
Accepted: 7 November 2017