Application of facial-submental artery island flap in reconstruction of oral and maxillofacial defects / 口腔疾病防治

@#The facial submental artery island flap (FSAIF) is a fasciocutaneous flap supplied by the facial submental artery. It is in close proximity with many oral and maxillofacial regions, and its tex ture and color are similar to those of the head and face. The flap has a constant and sufficient blood supply, and it is easy to prepare and has high survival rates and few complications. According to the tissue carried, FSAIF can be divided into fasciocutaneous flaps, myocutaneous flaps and simple flaps. The flap can also be made into an osteofasciocutaneous (myocutaneous) flap with a mandible to repair maxillary defects. Because this flap is a pedicled flap, it can greatly shorten the operation time, bed rest time and hospitalization time and has been widely used in repairing medium-sized defects of the oral and maxillofacial region. The indications for FSAIF in repairing maxillofacial defects should be strictly controlled. It can be safely used for benign or malignant tumors without cervical lymph node metastasis. For malignant tumors with cervical lymph node metastasis but without extranodal extension, the flap can be used on the premise of thorough neck dissection. The contraindication is cervical lymph node metastasis and extranodal extension of malignant tumors; therefore, other flaps should be selected for repair.

Colgajo en isla submental: Experiencia de 2 casos en reconstrucción de base de cráneo lateral

Resumen La cirugía reconstructiva de cabeza y cuello es una tarea compleja. Existen varias opciones disponibles para lograr buenos resultados, desde colgajos locales hasta colgajos libres microvascularizados. En este reporte presentamos nuestra experiencia utilizando el colgajo en isla submental para la reconstrucción de defectos de tejido blando de base de cráneo lateral posterior a una resección lateral de hueso temporal secundario a diagnósticos oncológicos otológicos. Se presentan datos demográficos, clínicos, quirúrgicos y resultados de dos pacientes intervenidos durante el primer semestre del año 2020, en los cuales se consiguió un adecuado resultado reconstructivo. Este colgajo es una opción confiable y versátil para reconstrucción en cabeza y cuello.

Abstract Reconstructive head and neck surgery is a complex task. There are several options available to achieve good results, from local flaps to free microvascular flaps. In this article, we present our experience using the submental island flap for soft tissue defect reconstruction of the lateral skull base after a lateral temporal bone resection secondary to otologic cancer. Demographic, clinical, surgical and outcome data of two patients operated on during the first semester of 2020 are presented, in whom a good reconstructive result was achieved. This flap is a reliable and versatile option for head and neck reconstruction.

Submental Endotracheal Intubation for Maxillofacial Surgery: A Report of Two Cases

The technique of submental endotracheal intubation has been established as a safe alternative to tracheostomy and can be utilized when oro-tracheal and naso-tracheal routes of intubation are not ideal for orofacial surgical intervention. The technique is simple and avoids the complications of tracheostomy. We present 2 cases of adults with orofacial injuries requiring surgery. Both cases were managed using the submental method of intubation and the procedure was well tolerated. There were no perioperative complications and patients were discharged on the fifth postoperative day.

Submental Endotracheal Intubation for Maxillofacial Surgery: A Report of Two Cases

The technique of submental endotracheal intubation has been established as a safe alternative to tracheostomy and can be utilized when oro-tracheal and naso-tracheal routes of intubation are not ideal for orofacial surgical intervention. The technique is simple and avoids the complications of tracheostomy. We present 2 cases of adults with orofacial injuries requiring surgery. Both cases were managed using the submental method of intubation and the procedure was well tolerated. There were no perioperative complications and patients were discharged on the fifth postoperative day.

Anesthesia for elective bilateral sagittal slip osteotomy of the mandible and genioplasty in a young man with Klippel-Feil syndrome, Sprengel deformity, and mandibular prognathism

Klippel-Feil syndrome is characterized by congenital fusion of two or more cervical vertebrae, a low hair line at the back of the head, restricted neck mobility, and other congenital anomalies. We report a 16-year-old young man with Klippel-Feil syndrome, Sprengel deformity of the right scapula, thoracic kyphoscoliosis, and mandibular prognathism with an anterior open bite. He was treated with orthodontic treatment and maxillofacial surgery. An anticipated difficult airway due to a short neck with restricted neck movements and extrinsic restrictive lung disease due to severe thoracic kyphoscoliosis increased his anesthesia risk. Due to his deviated nasal septum and contralateral inferior turbinate hypertrophy, we chose awake fiber optic orotracheal intubation followed by submental intubation. Considering the cervical vertebral fusion, he was carefully positioned during surgery to avoid potential spinal injury. He recovered well and his postoperative course was uneventful.

A Case of Mucinous Gland Adenomatoid Hamartoma Originated from Submental Space / 대한두경부종양학회지

Hamartomas are non-neoplastic malformations or congenital errors of tissue development. Hamartoma is composed by an excessive growth of mature tissue present in wrong proportions and abnormal arrangements. The lesion usually presents as a submucosal mass with ill-defined margins. Hamartoma occurs in all areas of the body, especially in the liver, spleen, kidney and lung. However, hamartoma is very rare in the head and neck. Presenting symptoms of hamartoma are typically vague and nonspecific. Treatment of hamartomas consists of adequate surgical excision. We present a 59 year-old male patient who presented with submental swelling. Malignancy could not be ruled out with preoperative radiologic examination, so surgical excision was planned. The mass was excised with transcervical approach. Histopathologic examination has confirmed the mass as a mucinous gland adenomatoid hamartoma.

Airway management through submental derivation: a safe and easily reproduced alternative for patients with complex facial trauma

OBJECTIVES: Airway management in patients with panfacial trauma is complicated. In addition to involving facial lesions, such trauma compromises the airway, and the use of intermaxillary fixation makes it difficult to secure ventilation by usual approaches (nasotracheal or endotracheal intubation). Submental airway derivation is an alternative to tracheostomy and nasotracheal intubation, allowing a permeable airway with minimal complications in complex patients. MATERIALS AND METHODS: This is a descriptive, retrospective study based on a review of medical records of all patients with facial trauma from January 2003 to May 2015. In total, 31 patients with complex factures requiring submental airway derivation were included. No complications such as bleeding, infection, vascular, glandular, or nervous lesions were presented in any of the patients. RESULTS: The use of submental airway derivation is a simple, safe, and easy method to ensure airway management. Moreover, it allows an easier reconstruction. CONCLUSION: Based on these results, we concluded that, if the relevant steps are followed, the use of submental intubation in the treatment of patients with complex facial trauma is a safe and effective option.

Effects of Neuromuscular Electrical Stimulation on the Swallowing Function in a Child - A Case Report / 대한연하장애학회지

This paper reports the effects of neuromuscular electrical stimulation (NMES) when applied to the facial muscles and submental region on a child with dysphagia. The subject was a 5 month girl who had hypoxic brain damage. Two electrodes were applied to the submental region horizontally (6.0 mA) and two electrodes were applied to each side of the mouth (5.0 mA). The child's jaw movement, swallowing food/liquid without excess loss, and swallowing without cough were improved. In addition, she could intake nutrition through the mouth. The result of the level on the Penetration Aspiration Scale (PAS) decreased from 4 to 1, the score on the Behavioral Assessment Scale of Oral Function in Feeding (BASOFF) increased from 13 to 17, and the level on the American Speech Language and Hearing Association: National outcomes measurements system (ASHA NOMS) increased from 1 to 3. When applying NMES to a child with dysphagia, the practitioner should consider various attachment places for improvements in the children's swallowing function.

Comparison of submental tumorigenesis model and axillary tumorigenesis model in nude mice xenotransplanted with human hypopharyngeal carcinoma cells / 第二军医大学学报

Objective To establish a submental tumorigenesis model by injecting human hypopharyngeal carcinoma cells to nude mice, and to compare the model with traditional axillary tumorigenesis model. Methods Five-week-old male nude mice were selected and divided into submental tumorigenesis model group (submental group) and axillary tumorigenesis model group (axillary group). Each group was divided into two subgroups by injecting human hypopharyngeal carcinoma cells FADU or HN31, namely sub-FADU, sub-HN31, ax-FADU, and ax-HN31 groups, with 12 nude mice in each group. The nude mice in the submental group were injected with tumor cells in the left side of submental area, and those in the axillary group were injected with tumor cells in the right side of axillary area. The time of tumor formation, tumor volume and body mass of nude mice were measured. The death of nude mice was recorded. After eight weeks, the local tumor growth, infiltration, and organ metastasis such as liver, spleen and kidney of the survival nude mice were examined by ultrasound, and the tumor metastasis was observed by routine H-E staining and immunohistochemical staining. Results On the 7th and 9th days after injection, the tumors were observed in the submental group and the axillary group. On the 33rd day after injection, the tumor volume in the ax-FADU and ax-HN31 groups was significantly bigger than those in the sub-FADU and sub-HN31 groups (P<0.05, P<0.01). The body mass of nude mice in each group reached peak on the 17th to 19th days after injection, and thereafter the body mass in the submental group was gradually decreased and that in the axillary group was still increased. On the 33rd day after injection, the body mass in the ax-FADU and ax-HN31 groups were significantly higher than those in the sub-FADU and sub-HN31 groups, respectively (P<0.01). After eight weeks, there were eight deaths in the sub-FADU group and 10 in the sub-HN31 group, with six mice alive in the submental group; there were six deaths in the ax-FADU group and six in the ax-HN31 group, with 12 alive in the axillary group. There was no significant difference in mortality of nude mice between the four subgroups. Ultrasound and pathological examination showed that four survived nude mice were found with cervical lymph node and liver metastases in the submental group, and only one was found with liver metastases in the axillary group; and the difference between the two groups was statistically significant (P<0.05). There were two pulmonary metastases in the submental group, and one in the axillary group; there was one spleen metastases in the submental group and no spleen metastases in the submental group; and there were no significant differences between the two groups. Conclusion Submental tumorigenesis model and axillary tumorigenesis model have their own characteristics. The submental tumorigenesis model has shorter tumorigenesis time, higher local invasion and higher distant metastasis rate, and is suitable for studying the invasiveness and metastasis of tumor in vivo. The axillary tumorigenesis model has larger volume of tumor, less injury to the adjacent organs and tissues, longer survival time and lower distant metastasis rate, and is suitable for the study of the characteristics of tumor cells.

Clinical application of submental artery perforator flap in oral and maxillofacial defect restoration after tumor resection / 中华口腔医学杂志

Objective@#To summarize the clinical anatomical features and surgical technique of the submental artery perforator flap (SMAPF), and to evaluate the outcome and value of the flap for oral cavity reconstruction after cancer ablation.@*Methods@#A total of 56 patients with oral cancer were included in this study. The modified SMAPF excluded the anterior belly of the digastric muscle and submental fatty tissue. The primary sites of malignancy were buccal mucosa (n=24), tongue (n=21), mandibular gingiva (n=6), mouth floor (n=3), soft palate (n=2).@*Results@#The flap size varied from 3 cm×5 cm to 5 cm×12 cm. Four flaps presented mild venous congestion, which was salvaged with conservative measures such as acupuncture and blood letting. Overall flap survival rate was 100%. The SMAPF with septocutaneous perforator was used in 49 cases and with musculocutaneous perforator in seven cases. External jugular vein and internal jugular vein provides venous drainage were applied in half cases respectively. All the patients showed a good recovery of tongue mobility and mouth opening with a follow-up of 3-41 months. Local recurrence was detected in one patient 4 months after operation.@*Conclusions@#The SMAPF is a reliable flap for oral cavity reconstruction with outstanding functional and aesthetic outcomes.

Submental island flap for repairing oral defect after radical resection of oral cancer / 天津医药

Objective To summarize the surgery skills and evaluate the clinical outcome of submental island flap for repairing oral defect after radical resection of oral cancer. Methods A total of 25 consecutive patients underwent submental island flap reconstruction after ablative surgery for oral cancer from January 2015 to May 2017 were enrolled in this study. The patterns of venous return, the technique notes and postoperative complications were summarized. The oncological safety of submental island flap in oral reconstruction was analyzed. Results The submental island flaps were harvested with the sizes ranging from(5 cm×3 cm)to(12 cm×5 cm).The mean operation time was(350.5±50.5)min.The vein of the flap was found to drain into the facial vein,and then returned to the internal jugular vein in 17 patients(68.0%), into the external jugular vein in 4 patients(16%),and into the anterior jugular vein in 4 patients(16%).Twenty-four flaps survived completely,and 1 flap failed due to the damage of the submental artery.Wound infection occurred in only 1 patient, and primary wound healing was observed in the other 24 patients. Eight patients (32.0%) with cervical lymph node metastases were verified by the postoperative pathological examination, 4 patients were submandibular lymph node metastases.The prevalence of occult lymph node metastasis involving level Ⅰwas 16.0%.The mean follow-up period was (14.3 ± 5.2) months. Local recurrence was found in 1 patient and cervical recurrence in 2 patients without postoperative radiotherapy during the follow-up. Conclusion There are three various drainage patterns for the venous return of submental island flap.Our data suggest that vein drainage of the flap into the external jugular vein and the anterior jugular vein,which are previously overlooked,should receive greater attention during the harvest of submental flap to avoid venous congestion and flap loss.Close follow-up or postoperative radiotherapy are recommended for patients without cervical lymph node metastases.

Retrograde submental intubation assisted with direct video laryngoscopy in maxillofacial trauma: technical note and case report / Intubación submentoniana retrógrada asistida con videolaringoscopía en trauma maxilofacial: nota técnica y reporte de caso

The management of a difficult airway is one of the biggest challenges of perioperative anesthesia management. The maxillofacial trauma can cause serious disturbances of the soft and hard tissues of the anatomical components of the upper airway and often with little external evidence of deformity. The submental intubation is a procedure that was reported to avoid tracheostomy and allow for the concomitant restoration of occlusion and reduction of facial fractures in patients with craniomaxillofacial trauma ineligibles for nasotracheal intubation. We described a modification of the original technique by performing a retrograde submental intubation assisted by direct laryngoscope video in a maxillofacial trauma patient with restricted mouth opening. In addition, the surgical anatomy of the technique is detailed described.

El manejo de una vía aérea difícil es uno de los mayores desafíos del manejo anestésico perioperatorio. El trauma maxilofacial puede causar serias alteraciones a los tejidos blandos y duros de la vía aérea superior, y muchas veces con pequeña evidencia externa de deformidad. La intubación submentoniana es un procedimiento que fue reportado para evitar la traqueostomía y permitir la concomitante restauración de la oclusión para la reducción de fracturas faciales en pacientes donde la intubación nasotraqueal está contraindicada. Describimos una modificación de la técnica original, realizando una intubación submentoniana retrógrada asistida con videolaringoscopio en un paciente de trauma maxilofacial con apertura de la cavidad disminuida. Adicionalmente se describe detalladamente la anatomía quirúrgica de la técnica.

Submental Lipoma-Clinical Report of the Case and Review of the Literature.

Lipomas is the commonest tumour of subcutaneous tissue. It may occur anywhere in the body, but are very infrequent in the head and neck. Clinically they confuse with other soft tissue masses, especially if the present in the head and neck region. Malignancy has to be ruled out if the large neck swelling with increased rapid recent growth. . Improved diagnostic imaging technology (such as CT or MRI) has been very beneficial for the knowledge of extension and surgical plan of the tumour mass.The best treatment modality so far has been surgical excision. In this present study, a 45-year-old woman who presented with a enlarged submental mass which was present since 2 months but has started growing rapidly since 15 days is described. Surgical excision under bilateral cervical block was performed. A 7cm ×4cm mass was successfully removed. The surgery produced no functional impairment and good cosmetic results. Review of literature is also included.

Submental ultrasonongraphy in assessing oropharyngeal swallowing disorders in children with cerebral palsy / 中华物理医学与康复杂志

Objective To explore the application of submental ultrasonongraphy (SUS) in the assessment of oropharyngeal swallowing disorders in children with cerebral palsy.Methods Seventeen children with cerebral palsy and oropharyngeal swallowing difficulties (7 on nasal feeding,10 on oral feeding) constituted the treatment group while 20 normal counterparts formed the control group.SUS was applied to measure any changes in the thickness of the tongue muscle and the range of hyoid bone displacement when they swallowed 5 ml of water.The results were compared with those assessed using the functional oral intake scale to decide the best cut-off point for detecting tube-feeding-dependent dysphagia.The intraclass correlation coefficient (ICC) of the 20 children in the control group was calculated to evaluate the intra-rater and inter-rater reliability of SUS.Results The average tongue muscle thickness change and hyoid bone displacement amplitude of the children on nasal feeding were significantly smaller than those of the children without nasal feeding and the normal children.The best cut-off point for the tongue muscle thickness change data was 1.0 cm,and that of the hyoid bone displacement amplitude was 1.5 cm.All of the ICCs were above 0.4,indicating good intra-rater and inter-rater reliability for the SUS examination.Conclusion Submental ultrasonongraphy can help assess the swallowing function of children with oropharyngeal swallowing disorders.

Three dimensionally reconstructed of the mandibular incisive canal by CBCT / 口腔疾病防治

Objective@#To find out the existence of Mandibular Incisive Canal (MIC) through CBCT scanning and measure its 3D relationship with the surrounding tissue, so as to provide protection for the operation in submental area. @*Methods@# CBCT images of 100 patients were measured and three dimensionally reconstructed. The measurement include following items, the existence of the MIC; vertical and horizontal diameter of MIC; vertical distance from MIC to the mandibular buccal and lingual wall; to the root apex, to the inferior border of mandible and alveolar crest in corresponding points (the mandibular first premolar, canine and incisor). @*Results @# the MIC was 100% visible in CBCT. The mean distance between MIC and buccal bone plate and lingual bone plate was 3.52 ± 0.54 mm and 5.37 ± 0.25 mm. The average distance from the inferior border of the mandible, the apex of the root and the crest of the alveolar bone was 10.44 ± 0.61 mm、10.57 ± 0.76 mm and 20.21 ± 0.83 mm relatively. The distance from MIC to the inferior border of the mandible in male was 10.70 ± 0.43 mm and 10.17 ± 0.63 mm in female, P<0.05. @*Conclusion @# The detection rate of MIC is high and there are many variations. It was suggested that the location and size of the MIC should be checked in CBCT in each patient before operation, which is helpful to avoid surgical complications in submental area.

Repair of upper lip scar by expanded submental flap / 中华医学美学美容杂志

Objective To discuss the repairing methods of the wound after upper lip lesion excision.Methods The wound after upper lip lesion excision was repaired by expanded pedicled submental flap.The 3 cm-long incision was located in 1 cm to sub-mandible.The 100 ml expander was placed beneath the platysma,and the aqueducts and spigots of the expanders were laid out of the skin.After complete expansion,the spastic scars of the upper lip and nasal bottom were resolved,the nasal columella and upper lip were put back to the normal position.The pedicled submental flap was transferred to the wound after upperlip excision according to the size of the wound.The pedicle was severed after 3 weeks.Results There were 5 cases of the expanded pedicled submental flap to repair the wound after upper lip excision.The flap survived without complications.The appearances were satisfied by the patients.Conclusions The method of the expanded submental flap is suitable for the wound after upper lip excision.

Surface electromyographic characteristics of the bilateral submental muscles in dysphagia secondary to uni-lateral brainstem stroke / 中华物理医学与康复杂志

Objective To observe the surface electromyographic characteristics of the bilateral submen-tal muscles in dysphagia secondary to unilateral brainstem stroke. Methods A total of 25 subjects were recrui-ted. There were 8 stroke patients with dysphagia secondary to a left brainstem stroke and 7 stroke patients with dysphagia secondary to a right brainstem stroke. There were also 10 healthy controls matched in age and gender. The duration and peak amplitude of the submental muscle when swallowing 5 ml of warm water were recorded u-sing a surface electromyograph. Results The average amplitude of the left submental muscle in patients with a left brainstem stroke was significantly longer than that of those with a right brainstem stroke, but no significant differences in average duration were observed. Conversely, the amplitude of the right submental muscle in pa-tients with a right brainstem stroke was significantly longer than that of those with left brainstem stroke, but again there were no significant differences in duration. No significant differences were observed among the healthy con-trols. The amplitude and duration of both the affected and healthy sides of the patients were of course significantly longer or stronger than those of the healthy controls. Conclusion The swallowing function of the bilateral sub-mental muscles may be impaired among unilateral stroke survivors with dysphagia. The damage on the affected side is more severe than on the opposite side.

Submental intubation: alternative short-term airway management in maxillofacial trauma

OBJECTIVES: To assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in cranio-maxillofacial trauma, along with an assessment of its morbidity and complications. MATERIALS AND METHODS: Submental intubation was performed in 17 patients who had maxillofacial panfacial trauma and management was done under general anesthesia during a period of one year from 2013 to 2014 at Departments of Oral and Maxillofacial Surgery and Dentistry, the Malankara Orthodox Syrian Church Medical College, Kochi, India. RESULTS: In all 17 cases, the technique of submental intubation was found to be simple and reliable. Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each. All these complications were managed comfortably without significant morbidity to the patient. CONCLUSION: Submental intubation is a good technique that can be used regularly in the management of the airway in cranio-maxillofacial trauma, but with some manageable complications.

Submental intubation in maxillofacial fracture: a case report

It can be challenging to create a safe airway in maxilla facial fracture and some skull surgeries. In this case study, the patient experienced jaw fractures that disturbed the dental occlusion and associated fracture of the base of the skull. Neither nasal nor oral intubation was possible based on the side effects of tracheotomy; therefore, submental intubation was applied successfully. The procedure and results are presented in the text.

Proposal of the New Term 'Leukoderma Nuchae' to Describe the Whitish Patch in the Spared Zone of Poikiloderma of Civatte to Differentiate It from Vitiligo / 대한피부과학회지

Poikiloderma of Civatte (PC) is a common, acquired condition that affects the face, neck, and upper chest of elderly persons due to life-long sun exposure. Poikiloderma describes skin manifestations of atrophic and telangiectatic lesions with pigmentary changes. We experienced three cases of patients who visited our department due to whitish patches on the anterior neck, which had been treated as vitiligo at private dermatological clinics. The patches mimicked vitiligo to the naked eye due to their color and relatively well-demarcated margin, but they were not accentuated under Wood's light. On MART-1 staining, there was no loss of melanocytes in the basal cell layer of the epidermis. Leukoderma on the anterior neck might be produced due to contrast with the neighboring skin showing PC. Based on our experiences, we propose a new dermatological term, 'leukoderma nuchae (LN)', to describe the spared zone of PC, to aid in differentiating this condition from vitiligo.