Reconstruction of Lateral Mandibular Defects with Soft Tissue Loss: The Role of the Submental Flap

Document Type : Original


1 Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.


Mandibular continuity defects after pathologic resections or traumatic events are difficult cases for reconstruction. Defects involving both hard and soft tissue loss are more challenging, because of problems in soft tissue coverage. The role of the submental flap in this regard is presented.
Materials and Methods:
In a retrospective study from the archived files of Ghaem Hospital, Mashhad, Iran between 2007–2016, lateral mandibular defects that were managed with submental flap for soft tissue coverage were selected.
Ten patients had been treated, of whom four cases were due to trauma/gunshot events and six cases were defined as pathologic resection; five patients with malignant lesions and one with benign intraosseous pathology, but with soft tissue invasion. There was one complication overall, concerning orocutaneous fistula formation.
Submental flap is indicated for coverage of the reconstruction plate when the lateral mandible is resected/avulsed with soft tissue loss limited to the oral cavity or due to through and through defects in the lower third of the face.


Main Subjects

1. Bak M, Jacobson AS, Buchbinder D, Urken ML. Contemporary reconstruction of the mandible. Oral Oncol  2010;46(2):71-6.
2. Guerrier G, Alaqeeli A, Al Jawadi A, Foote N, Baron E, Albustanji A. Reconstruction of residual mandibular defects by iliac crest bone graft in war-wounded Iraqi civilians, 2006-2011. Br J Oral Maxillofac Surg 2015;53(6):e27-31.
3. Adebayo ET, Fomete B, Adekeye EO. Delayed soft tissue recurrence after treatment of ameloblastoma in a black African: case report and review of the literature. J Craniomaxillofac Surg  2011 ;39(8):615-8.
4. Kruse AL, Bredell M, Gratz KW. Oral squamous cell carcinoma in non-smoking and non-drinking patients. Head Neck Oncol  2010;2:24.
5. Kummoona RK. Missile war injuries of the face J Craniofac Surg  2011 ;22(6):2017-21.
6. Mueller S, Gosau M, Wendl CM, Prantl L, Wiggermann P, Reichert TE, et al. Postoperative evaluation of microvascularization in mandibular reconstructions with microvascular flaps - first results with a new perfusion software for contrast-enhanced sonography (CEUS). Clin Hemorheol Microcirc 2012;52(2-4):187-96.
7. El-Zohairy MA, Mostafa A, Amin A, Abd El-Fattah H, Khalifa S. Mandibular reconstruction using pectoralis major myocutaneous flap and titanium plates after ablative surgery for locally advanced tumors of the oral cavity. J Egypt Natl Canc Inst  2009;21(4):299-307.
8. Kumar V, Singh AK, Kumar P, Shenoy YR, Verma AK, Borole AJ, et al. Blast injury face: An exemplified review of management. Natl J Maxillofac Surg  2013 ;4(1):33-9.
9. Lockhart R, Menard P, Chout P, Favre-Dauvergne E, Berard P, Bertrand JC. Infrahyoid myocutaneous flap in reconstructive maxillofacial cancer and trauma surgery. Int J Oral Maxillofac Surg 1998;27(1):40-4.
10. Mehta RP, Deschler DG. Mandibular reconstruction in 2004: an analysis of different techniques. Curr Opin Otolaryngol Head Neck Surg  2004 ;12(4):288-93.
11. Brown JS, Lowe D, Kanatas A, Schache A. Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg  2017 ;55(2):113-126.
12. Patel AV, Thuener JE, Clancy K, Ascha M, Manzoor NF, Zender CA. Submental artery island flap versus free flap reconstruction of lateral facial soft tissue and parotidectomy defects: Comparison of outcomes and patient factors. Oral Oncol  2018;78:194-199.
13. Rahpeyma A, Khajehahmadi S. Reconstruction of the maxilla by submental flap. ANZ J Surg 2015 ;85(11):873-7.
14. Rahpeyma A, Khajehahmadi S. Submental artery island flap in intraoral reconstruction: a review. J Craniomaxillofac Surg 2014;42(6):983-9.
15. Rahpeyma A, Khajehahmadi S. Oral reconstruction with submental flap. Ann Maxillofac Surg 2013 ;3(2):144-7.
16. Wong RC, Tideman H, Kin L, Merkx MA. Biomechanics of mandibular reconstruction: a review. Int J Oral Maxillofac Surg  2010; 39(4): 313-9.
17. Benson PD, Marshall MK, Engelstad ME, Kushner GM, Alpert B. The use of immediate bone grafting in reconstruction of clinically infected mandibular fractures: bone grafts in the presence of pus. J Oral Maxillofac Surg 2006 ;64(1):122-6.