Submandibular gland flap in reconstruction of head and neck cancer defects


  • Viresh Arora Department of ENT, United Lincolnshire hospitals trust (ULHT), UK
  • Bhushan Kathuria Kainos Super Specialty Hospital Rohtak, Haryana, India
  • Madhuri Arora Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India



Submandibular gland, Reconstruction, Head and neck defects, Squamous cell carcinoma, Submandibular gland flap


Management of head and neck cancer defects has been challenging owing to the complexity of the created defects. Various local and regional flaps to free flaps have been described in the reconstruction of cancer defects, each of them having it’s own merits and limitations, therefore none of them appears as an ideal one. A Submandibular gland flap (SMGF) technique has emerged as a versatile flap having advantages of a regional and a free flap. In this study, eleven patients (four tongue, six buccal mucosa defects and one retromolar trigone defect) underwent reconstruction of oral cavity cancer defects with SMGF. The outcomes of the SMGF were evaluated in terms of the ease of harvest, functional outcome, and postoperative complications. The mean defect size and the flap dimensions were 4.4×3.9 cm and 3.6×3.3 cm respectively. One patient suffered wound infection resulting in partial flap necrosis with wound dehiscence. In the follow-up period one patient developed contra nodal recurrence and another patient developed a second primary on the contralateral base of the tongue. This study showed that SMGF is an excellent flap for the reconstruction of oral cavity cancer defects because of its reliability, versatility and its relative ease of application.

Author Biographies

Viresh Arora, Department of ENT, United Lincolnshire hospitals trust (ULHT), UK

Consultant ENT

Bhushan Kathuria, Kainos Super Specialty Hospital Rohtak, Haryana, India

Consultant ENT


Kessler AT, Bhatt AA. Review of the Major and Minor Salivary Glands, Part 1: Anatomy, Infectious, and Inflammatory Processes. J Clin Imaging Sci. 2018;15:47.

Chua DY, Ko C, Lu KS. Submandibular mass excision in an Asian population: a 10-year review. Ann Acad Med Singapore. 2010;39:33-7.

Rapidis AD, Stavrianos S, Lagogiannis G. Tumors of the submandibular gland: clinicopathologic analysis of 23 patients. J Oral Maxillofac Surg. 2004;62:1203‐8.

Hanasono MM, Friel MT, Klem C. Impact of reconstructive microsurgery in patients with advanced oral cavity cancers. Head and Neck. 2009;31:1289-96.

Yang B, Su M, Li H. Use of submandibular gland flap for repairing defects after tumor resection in the infratemporal region. J Craniomaxillofacial Surg. 2015;43:87-91.

Mashrah MA, Zhou SH, Abdelrehem A. Oropharyngeal reconstruction with a pedicled submandibular gland flap. Br J Oral Maxillofac Surg. 2016;54:388-93.

Hanasono MM. Reconstructive Surgery for Head and Neck Cancer Patients. Adv Med. 2014;2014:795483.

Stott-Miller M, Chen C, Chuang SC. History of diabetes and risk of head and neck cancer: a pooled analysis from the international head and neck cancer epidemiology consortium. Cancer Epidemiol Biomarkers Prev. 2012;21:294-304.

Cansiz E, Gozen ED, Yener M. Closure of Orocutaneous Fistula Using Submandibular Gland as a Pedicled Flap. Case Reports in Dentistry. 2019;2019:3438626.

Zhang X, Liu F, Lan X. Combined submandibular gland flap and sternocleidomastoid musculocutaneous flap for postoperative reconstruction in older aged patients with oral cavity and oropharyngeal cancers. World J Surg Oncol. 2014;15:259.

Ou XR, Su T, Huang L. A comparative study between submandibular-facial artery island flaps (including perforator flap) and submental artery perforator flap: A novel flap in oral cavity reconstruction. Oral Oncol. 2019;99:104446.

Yang L, Wei J, Wang W. Use of a submandibular gland flap for closure of oral cutaneous fistula. Oral Oncol. 2020;104:104583.

Chim H, Salgado CJ, Seselgyte R. Principles of head and neck reconstruction: an algorithm to guide flap selection. Semin Plast Surg. 2010;24:148-54.

Beahm DD, Peleaz L, Nuss DW, Carlos. Surgical approaches to the submandibular gland: a review of literature. Int J Surg. 2009;7:503-09.

Abouchadi A, Capon-Degardin N, Patenôtre P. The Submental Flap in Facial Reconstruction: Advantages and Limitations. J Oral Maxillofac Surg. 2007;65:863-9.

Mozolewski E, Maj P, Kordowski J. Vascular pedicle flap of the thyroid or submandibular gland in the reconstruction following partial laryngectomy. Otolaryngol Pol. 1999;53:387-96.

Giordano L, Di Santo D, Bondi S. The supraclavicular artery island flap (SCAIF) in head and neck reconstruction: an Italian multi-institutional experience. Acta Otorhinolaryngol Ital. 2018;38:497‐503.

Ramirez, AT Chiesa-Estomba CM, Gonzaez-García, JA. Submental Artery Island Flap in Oral Cavity Reconstruction. An Observational, Retrospective Two-centre Study. Int Arch Otorhinolaryngol. 2020.04.

Kokot N, Mazhar K, Reder LS. The supraclavicular artery island flap in head and neck reconstruction: applications and limitations. JAMA Otolaryngol Head Neck Surg. 2013;139:1247‐55.

Sittitrai P, Srivanitchapoom C, Reunmakkaew D. Submental island flap reconstruction in oral cavity cancer patients with level I lymph node metastasis. Br J Oral Maxillofac Surg. 2017;55:251‐5.

Guha G, Chatterjee D, Biswas S. Evaluation of facial artery perforator-based flaps in reconstruction of facial defects. Indian J Plast Surg. 2017;50:266-72.

Yadav SK, Shrestha S. Current and Advancing Concepts in Pedicled Flaps, Old and New, for Oral and Maxillofacial Reconstruction. Med Clin Rev. 2012;2:9.

Kuk SK, Kim BK, Yoon HJ. Investigation on the age and location of oral squamous cell carcinoma incidence in Korea. Korean J Oral Maxillofac Pathol. 2015;39:393-402.

Chakrabarti S, Chakrabarti PR, Desai SM. Reconstruction in oral malignancy: Factors affecting morbidity of various procedures. Ann Maxillofac Surg. 2015;5:191-7.

Stanford-Moore G, Bradshaw PT, Weissler MC. Interaction between known risk factors for head and neck cancer and socioeconomic status: the Carolina Head and Neck Cancer Study. Cancer Causes Control. 2018;29:863‐73.

Lekawale HS, Gaidole RV. Supraclavicular artery island flap in the reconstruction of oral cavity cancer defects. Int J Surg. 2019;6:3733-8.

Copelli C, Tewfik K, Cassano L. Management of free flap failure in head and neck surgery. Gestione del fallimento dei lembi liberi in chirurgia testa-collo. Acta Otorhinolaryngol Ital. 2017;37:387-92.

Tan BK, Por YC, Chen HC. Complications of head and neck reconstruction and their treatment. Semin Plast Surg. 2010;24:288-98.

Eskander A, Kang S, Tweel B. Predictors of complications in patients receiving head and neck free flap reconstructive procedures. Otolaryngol Neck Surg. 2018;158:839-47.

Kansy K, Hoffmann J, Alhalabi O. Long-term donor site morbidity in head and neck cancer patients and its impact on quality of life: a cross-sectional study. Int J Oral Maxillofac Surg. 2019;48:875-85.

Hudgins PA. Flap reconstruction in the head and neck: expected appearance, complications, and recurrent disease. Eur J Radiol. 2002; 44:130-8.

Chen W, Yang Z, Zhang D. Second salvage surgery with extended vertical lower trapezius island myocutaneous flap reconstruction for advanced re-recurrent oral and oropharyngeal squamous cell carcinoma. Int J Oral Maxillofac Surg. 2014;43:531-8.

Cakir AC, Dogan E, Ozay H. Submandibular gland invasion and feasibility of gland-sparing neck dissection in oral cavity carcinoma. J Laryngol Otol. 2018;1-6.






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