Comparing Outcomes of Pedicled Submandibular Gland Flap and Submental Artery Perforator Flap in Oral Cavity Reconstruction.

Abstract

Objective: Submandibular gland flap (SMGF) has demonstrated reliability in repairing small- to medium-sized defects, yet it has not gained widespread international adoption. This study aimed to evaluate the efficacy and outcomes of SMGF for oral cancer reconstruction and compare its application with submental artery perforator flap (SMAPF).

Methods: All patients with primary oral cancer requiring reconstruction using either SMGF or SMAPF were included. Demographic and surgical outcome measures (such as harvesting time, use of lip splinting, and marginal mandibulectomy), short-term outcomes (including flap partial loss, intraoral wound dehiscence, fistula, oral bleeding, and wound infection), and long-term morbidity (including cancer recurrence, neck motion restriction, hair growth, and overall aesthetic outcomes) were assessed.

Results: Thirty-seven patients were enrolled (SMGF, n = 16; SMAPF, n = 21). The SMGF group was older than the SMAPF group and had a shorter harvesting time (p < 0.05). Flap partial loss and neck motion restriction occurred in 3 patients in the SMAPF group. Nine patients experienced locoregional recurrence (SMGF, n = 3; SMAPF, n = 6). A significantly higher incidence of hair growth was observed in the SMAPF group (47.6%, p = 0.002). No significant difference was found in satisfaction with appearance between the two groups. There were no flap losses in the study.

Conclusion: SMGF reconstruction is a valuable technique, comparable to SMAPF, for repairing appropriately selected intraoral defects requiring reconstruction beyond healing by secondary intention and mobilization of adjacent tissue, but it is not large enough to necessitate free flap reconstruction.