COMPARISON OF COMPLICATIONS AND FUNCTIONAL OUTCOMES OF SUBMENTAL ISLAND FLAP VS RADIAL FOREARM FLAP FOR RECONSTRUCTION OF TONGUE DEFECTS IN SQUAMOUS CELL CARCINOMA
DOI:
https://doi.org/10.33279/jkcd.v15i04.968Keywords:
submental island flap, reconstruction, squamous cell carcinomaAbstract
Objectives: To compare postoperative complications and functional outcomes of submental island flap versus radial forearm used in reconstruction of tongue defects in squamous cell carcinoma patients.
Materials and Methods: After receiving approval from the Ethical Review Committee, this study was carried out in a tertiary care center's Department of Oral and Maxillofacial Surgery (Ref. No: 10130425MAOM). It comprised 60 patients in a non- randomized control trial, 30 in each group, between the ages of 18 and 70, who were undergoing surgical reconstruction and resection for squamous cell carcinoma of the tongue. Depending on the size of the defect, patients were randomized to either the radial forearm free flap group or the submental island fl ap group. Poor nutrition (BMI <18.5 or >35), substance abuse, active oral infections, severe comorbidities, previous head and neck radiation, recurrent disease, and prior reconstruction were all excluded. Adults aged 18–70 years undergoing tongue reconstruction were included. Functional outcomes (speech, swallowing, mobility) and complications (infection, wound dehiscence, necrosis, donor-site morbidity) were assessed at 1-week and 15-day follow-up. Data were analyzed with SPSS 22 using chi-square/Fisher’s exact tests, with eff ect sizes and 95% confi dence intervals reported. Qualitative variables were presented as percentages and frequencies, while quantitative variables were summarized as mean ± SD or IQR. A p-value of less than 0.05 was deemed statistically significant.
Results: Among the 159 participants, the mean age was 33.08 ± 8.83years, with a higher proportion of males (n=95, 59.7%). While most respondents recognized the benefits of laser technology in endodontics, practical application was limited, with only 4.4% reporting its use. Significant differences were observed between respondents with 1-4 years and 5-8 years of experience in their familiarity with laser technology and beliefs about its application and outcomes. Barriers to adoption included cost concerns and perceived training accessibility.
Conclusion: For tongue reconstruction, RFFF and SMIF both demonstrated comparable healing and functional results, demonstrating their efficacy and dependability. However, SMIF provides a less invasive alternative that is perfect for moderate defects because it requires less time during surgery and has less donor-site morbidity.
References
Krishnatreya M, Nandy P, Rahman T, Sharma JD, Das A, Kataki AC, et al. Characteristics of oral tongue and base of the tongue cancer: a hospital cancer registry based analysis. Asian Pacific Journal of Cancer Prevention. 2015;1 6(4): 1 37 1-4.
Yu GP, Mehta V, Branovan D, Huang Q, Hashibe M, Zhang ZF, Schantz SP. Improved survival among patients with base of tongue and tonsil cancer in the United States. Cancer Causes & Control. 2012 Jan;23(1):15364.
Khan MN, Perez E, Goljo E, Iloreta A, Park RC, Genden EM, Miles BA. The price of free tissue transfer after tongue reconstruction: quantifying the risks. The Laryngoscope. 2017 Jul;127(7):1551-7.
Larn L, Samman N. Speech and swallowing following tongue cancer surgery and free flap reconstruction-a systematic review. Oral oncology. 2013 Jun I i4g(6):SOT -24.
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. The Journal of Laryngology & Otology. 2019 May;133(S):413-8.
Kerawala C, Roques T, Jeannon JP, Bisase B. Oral cavity and lip cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016;130(suppl S2):S83–9
Wang Y, Zhou B, Chen WL, Huang ZX, Chen R. Facial-submental island flap for reconstruction of hemitongue defects in young, middle-aged and elderly patients with early and middle stage oral tongue squamous cell carcinoma. Head & Face Medicine.2O2Z Dec 5;19(i):39.
Gonzalez-Garcia R, Rodriguez-campo FJ, Naval-Gias L, sastre-p6rez J, Munroz-Guerra MF, Usandizaga JG, Dlaz-Gonz6lez FJ. Radial forearm free flap for reconstruction of the oral cavity.
Eker c. Reconstruction with Submental lsland Flap in oral cavity Tumors: Advantages and Disadvantages in the current Approach. J cukurova Anesth surg. 2ozz;5(3):404-r2.
Chen H, et al. Comparison of morbidity after reconstruction of tongue defects with an anterolateral thigh cutaneous flap compared with a radial forearm free-flap: a meta- analysis. Br J Oral Maxillofac Surg (2016)
Sittitrai P, Reunmakkaew D, Srivanitchapoom C. Submental island fl ap versus radial forearm free flap for oral tongue reconstruction: a comparison of complications and functional outcomes. The Journal of Laryngology & Otology. 2019 May;133(5):413-8.
Paydarfar JA, Patel UA. Submental island pedicled flap vs radial forearm free fl ap for oral reconstruction: comparison of outcomes. Archives of Otolaryngology–Head & Neck Surgery. 2011 Jan 17;137(1):82-7.
Mooney SM, Sukato DC, Azoulay O, Rosenfeld RM. Systematic review of submental artery island fl ap versus free flap in head and neck reconstruction. American journal of otolaryngology. 2021 Nov 1;42(6):103142.
Forner D, Phillips T, Rigby M, Hart R, Taylor M, Trites J. Submental island fl ap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction: a case series and cost analysis. Journal of Otolaryngology-Head & Neck Surgery. 2016 Jan;45(1):11.
Karimi E, Hashemi Z, Sohrabpour S, Mousavi SM, Yousefi J. Comparison of swallowing disorder in patients with tongue cancer undergoing reconstruction with either a radial forearm free flap or a submental island flap. Oral and Maxillofacial Surgery. 2024 Mar;28(1):125-30.
Chaudhuri GR. Reliability of Free Radial Forearm Flap for Tongue Reconstruction Following Oncosurgical Resection. Bengal Journal of Otolaryngology and Head Neck Surgery. 2015 Aug 1;23(2):57-62.
Bagheri SC. Reconstructive oral and maxillofacial surgery. InClinical review of oral and maxillofacial surgery 2008 Jan 1 (pp. 263-302). Mosby.
Rieger JM, Zalmanowitz JG, Li SY, Sytsanko A, Harris J, Williams D, Seikaly H. Functional outcomes after surgical reconstruction of the base of tongue using the radial forearm free fl ap in patients with oropharyngeal carcinoma. Head & Neck: Journal for the Sciences and Specialties of the Head and Neck. 2007 Nov;29(11):1024-32.
Khan Z, Saleem M, Khan I, Rahman MF. Functional Outcomes of Tongue Reconstruction After Cancer Extirpation in Diff erent Flaps: Pedicled Versus Free Flaps: A Systematic Review. Plastic and Reconstructive Surgery–Global Open. 2025 Oct 1;13(10):e7100.
Kamali A, Skogh AC, Nord ÅE, Lundgren K, Jergovic D, Nordenvall LH, Sommar P, Halle M. Increased salvage rates with early reexploration: a retrospective analysis of 547 free flap cases. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2021 Oct 1;74(10):2479-85.
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