Repair defects after endoscopic debridement of head and neck cancer carcinoma with prior irradiation of submental flaps

Repair defects after endoscopic debridement of head and neck cancer carcinoma with prior irradiation of submental flaps | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Repair defects after endoscopic debridement of head and neck cancer carcinoma with prior irradiation of submental flaps Xinrui Zhang, Yaoxin Zhao, Yingqi Wang, Haiqiong Huang, Huimin Ma, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4592780/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: To explore the feasibility and effect of submental flaps to repair the head and neck carcinoma with prior irradiation after endoscopic surgery. Methods: This study retrospectively analysed five cases with necrotic or recurrent of head and neck malignant tumours of post radiation after endoscopic surgery in our department from January 2023 to December 2023, including five males and aged 43–60 years. After endoscopic resection, the submental flap was prefabricated to repair the nasopharynx or oropharynx postoperative defects. Results: All cases in which flaps were used survived, and the average size of the SF used to repair the defects was 12–15 cm by 6–7 cm. All the patients had nasal feeding and the tracheal cannula was removed hospital discharge. Among them, patients with soft palate cancer repair had mild nasal reflux symptoms with smooth breathing. Upon intraoperative evaluation, all five patients had SF venous drainage, as well as nasal blockage and inadequate nasal ventilation. During the follow-up period 6–12 months, no visible ulcer surface or dry scab formation was seen. Conclusions： This study features the use of a submental flap to repair the head and neck defects with prior irradiation after endoscopic surgery, and it is a simple and fast procedure with adequate tissue and good arteriovenous blood supply to adjacent sites. This method is reliable and effective for postoperative defect repair of head and neck carcinoma, and it is worthy of widespread promotion. head and neck reconstruction endoscopic surgery submental flap defect repair Figures Figure 1 Figure 2 Background A variety of surgical techniques have been designed to reconstruct defects left by cancer ablation[1]. Technological advancements made it possible to reduce the high morbidity and mortality by introducing less invasive techniques, such as endoscopic debridement of nasopharyngeal or oropharynx lesions, which could be used nasally, transorally, or orally. After radical surgery, postoperative defect will be broad and require tissue repair and reconstruction. The gold standard for reconstructing head and neck malignancies has been free tissue transfers, such as the radial forearm free flap[2]. These procedures are associated with a prolonged operating time and require extensive surgical team expertise, ultimately elevating costs for healthcare providers[3]. Furthermore, patients who have undergone head and neck chemoradiotherapy are at a higher risk of vascular anastomosis failure due to the use of micro-vascularized free flaps[4–6]. Submental flaps (SFs) have become a popular option in the fast-track surgery era for head and neck cancer. And there are also many benefits, including shorter surgery time, less resource-intensive postoperative care, color and texture resembling the head and neck, even specialized operating room equipment, personnel, postoperative care and advanced microvascular fellowship training are usually not required[7, 8]. We have performed endoscopic debridement of oropharyngeal or nasopharyngeal lesions with previous irradiation, meanwhile the transcervical parapharyngeal space was exposed in the past few years. We have found that repairment with a local pedicl SF on the nasopharynx through the parapharyngeal space is reliable. The aim of this study was to evaluate the feasibility and effect of SF to repair the head and neck carcinoma with prior irradiation after endoscopic surgery. Methods 2.1 Clinical data: We collected data from five patients, five of whom were male and ranged in age from 43 to 70 years, who underwent endoscopic debridement for nasopharyngeal or oropharyngeal lesions between 2022 and 2023 with the SF for post-operative reconstruction. Each of the five patients had received radiation therapy previously before surgery, neoplasm recurrence or radionecrosis was confirmed clinically and pathologically. Additionally, endoscopic findings, radiological studies, and clinical characteristics (such as headache and/or foul odor) were finished. In cases where the diseased tissue encircled the carotid artery, patients who tested negative for balloon occlusion test (BOT) underwent unilateral internal carotid artery (ICA) embolization; those who tested positive or negative for BOT underwent unilateral ICA embolization and had endovascular stent grafting implanted. Patients with pathology-confirmed negative results underwent debridement. 2.2 Surgical methods. 2.2.1 Endoscopic radical procedure Every patient who was enrolled had an endoscopic radical operation. The lesion tissues were removed by wide debridement using low temperature plasma and a microdebrider, either with or without the assistance of an endoscopic drill. A frozen biopsy was subsequently conducted to rule out a positive operative margin. To prevent carotid artery rupture, great care was taken when debriding on the posterolateral side. Following debridement, we irrigated the area extensively with normal saline. 2.2.2 Preparation and design of SF Preoperative 0.5 mm thin-layer enhanced computerized tomography (CT) scans were performed on all patients, and CT venous images were continually scanned. The return vein was kept in the SF as per the preoperative CT prognosis, which was to confirm its presence. The root pedicle was prepared in the main body of the lesion on the ipsilateral side of the mental flap. The upper margin of the flap was designed along the lower margin of the mandible (0.5 cm from the mandible lower margin), extending from the lateral side of the submandibular gland on the pedicle side to the mandibular angle on the opposite side of the pedicle. The lower margin of the flap was situated between the thyroid cartilage and the hyoid bone in the median front of the neck. The skin, subcutaneous, and platysma muscles were cut and dissected on the surface of the facial artery at the mandibular angle in accordance with the intended flap. The marginal mandibular branch of facial nerve was dissected and protected; the anterior belly of the affected side's digastric muscle was severed at the chin to safeguard the flap vascular pedicle because of highly radiated tissues or necks devoid of vessels. The submental artery, which was shielded on the side of the chin flap, was located between the upper and lower margins of the submandibular gland and the jaw. The refluxing vein was verified by the preoperative CT scan and subsequently preserved in the SF. The submandibular gland was either removed or preserved at the base of the SF depending on how it related to the submental artery, reflux vein, and other structures. 2.2.3 SF repair the head and neck defects Pay attention to the protection of the SF root (root torsion < 180°) and reconfirm the blood flow to the distal SF, and the epidermis at the proximal end of the preset submental flap was removed as appropriate to extend the pedicle. Additionally, the SF was flattened to completely cover the postoperative defects through the posterior medial angle of mandible-posterior pterygoid muscle-parapharyngeal space channel to the nasopharynx, or through anterior parapharyngeal space to the oropharynx, as well as the SF skin surface facing the pharyngeal cavity. The parapharyngeal space and SF were sutured in paraposition based on the positional relationship between the defects and SF. The nasopharynx defect was then filled with a gelatin sponge, which moderately compressed and fixed the SF on the nasopharynx. Finally, the porcine fibrin sealant kit was dripped onto the surface of the gelatin sponge. In every case, the subcutaneous skin is sutured layer by layer, a negative pressure drainage tube is positioned in the parapharyngeal space and neck, and a tracheostomy is planned. 2.3 Postoperative treatment The patient was told to bend his neck as much as he could forward. On the SP pedicle, compression was not permitted. Oral hygiene was stressed, and symptomatic, anti-inflammatory therapy was given. Two days following the procedure, the postoperative MRI was examined in order to assess the effects of both the surgery and the SF blood supply. Results Three of the five patients had necrotic and decaying materials from previous radiation therapy, two had tumor recurrence, and all five had negative incisive margins. An average of 6.8 hours were spent on the procedure, and 110 milliliters of blood were lost. About 16 days following the procedure, the patients were released from the hospital. After the procedure, the nasal packing was removed 10–14 days later. The average size of the SF used to repair the defects was 12–15 cm by 6–7 cm, and all of the flaps remained intact following surgery. Two weeks following the tracheotomy, the cannula was painlessly removed from each patient. Upon intraoperative evaluation, it was determined that all five patients had SF venous drainage, as well as nasal blockage and inadequate nasal ventilation as a result of the SF swelling after surgery. After the surgery, the SF progressively shrank and turned into a mucosal membrane with adequate ventilation three to six months later. During the follow-up period, no visible ulcer surface or dry scab formation was seen. Five patients were followed up for 6–12 months till April 2024. No patient experienced a recurrence of nasopharyngeal or oropharyngeal carcinoma and cervical lymph node following the final operation throughout the 6- to 12-month follow-up period. Following surgery, the tracheal tube can be withdrawn, and the quality of the articulation is good. Discussion There are significant abnormalities in the head and neck following excision, and there is disagreement over the best way to manage postoperative wound complications, such as no repair, nasal mucosa flap repair, and temporalis muscle and free flap repair[9]. Following radiation therapy, a large number of patients with head and neck cancer have poor eating habits, chronic nutritional deficiencies, vascular sclerosis, and other poor vascular abnormalities. Vascular crises are most likely to occur in these people. For the reconstruction of big defects, the SF has become a more viable option than the free flap due to the presence of vascular deficient necks or severely radiated tissues. We tried to develop SF to fix head and neck cancer flaws from endoscopic surgery that had previously been exposed to radiation. In 1993, Martin et al first reported the anatomical and clinical characteristics of the submental flap (or submental island flap, submental artery island flap) [10]. Based on the submental branch of the facial artery and venous system, the flap has a thin, malleable thickness[11]. The patient's bodily condition determines the available skin size, which can vary greatly. The literature has recorded SF volumes as large as 22 cm–7 cm, and this volume is totally modifiable[12, 13]. For the majority of head and neck deformities, the SF has an excellent arc of rotation and a strong reconstructive result. Since Martin et al introduced SF[10], it has a broad rotation arc and may reach defects in the upper airway[13], the oral cavity[14], oropharynx[15], nasopharynx[16], and skull base[4] et al. Previous research[8, 17, 18] has demonstrated that the application of SF for head and neck reconstruction has several benefits, such as being simple to harvest during the same surgical procedure, having flexible rotation and being close to sites of head and neck defects, resulting in less trauma and complications, a good quality of life following surgery, requiring less time and money than free tissue transfer without significantly affecting functional outcomes or complication rates, and having donor site scarring that can be easily hidden behind the mandible with good aesthetic effect. In this study, SF was mostly used to treat postoperative problems in individuals who had nasopharyngeal radionecrosis. To the best of our knowledge, there haven't been many reports of using SF for nasopharyngeal radionecrosis yet. In our investigation, the majority of the parapharyngeal constrictor muscles had to be excised in order to guarantee that the surrounding marginal tissues were effectively vascularized. Following the resection of nasopharyngeal radionecrosis, the defect measured 7–8 cm by 4–5 cm. After surgery, the local blood vessels and base bone of the skull may become exposed. This can result in intractable ulcers, local callus formation, necrosis, infection, and bleeding, all of which can have a serious negative impact on the quality of life of patien[19]. Therefore, for coverage and healing, the defect needs a tissue flap of the proper size. Because the nasopharynx is surrounded by bony structures, the nasal mucosa is the only nearby tissue that can be utilized [20, 21]. Nevertheless, the blood supply of the nasal septal valve was easy to be affected by nasopharyngeal malignant invasion, or nasal septum perforation occurred after radiotherapy and they are thin and relatively small, making these flaps unsuitable for the repair of large nasopharyngeal defects. Compared with nasal mucosa flaps, SF is an ideal and reliable repair material for nasopharyngeal defects with or without oropharyngeal defects [22]. The SF with the overlying skin can be used to repair the pharynx, and we used the posterior medial angle of mandible - posterior pterygoid muscle - parapharyngeal space channel to push the SF up to the nasopharynx, and anterior parapharyngeal space to push the SF up to the oropharynx. Additionally, the parapharyngeal space dissection and SF donor location are both done through the same incision, which makes the surgery less invasive, faster, and more convenient than other flap procedures. When designing an SF, the reflux vein's path is unknown, but the submental artery's course for the SF blood supply is largely consistent[9, 23]. Because there are many variations in the submental vein returning to the proximal cardiac vein, the abnormal venous return also appears in the perioperative period of the mental flap. Thus, the primary cause of flap stasis necrosis is vascular crisis[9, 24]. This study used enhanced CT of the neck and preoperative thin slice scanning to anticipate venous return and misalignment. This information guided intraoperative mental regurgitation and significantly increased the rate of SF survival and manufacturing speed. When SP was constructed, the anterior belly of the afflicted side's digastric muscle was severed at the chin to safeguard the flap vascular pedicle. In all five of our patients, using an SF to repair was successful; no bleeding, infection, or local necrosis happened. Our findings appear to corroborate those of other researchers who have demonstrated the clinical utility and safety of the SF in individuals who have had prior neck radiation[7, 25]. There is no doubt that this study has several shortcomings. This was a retrospective study with only five patients, a small sample size, and a brief follow-up period of 4–12 months. However, the fact that all of the instances that were evaluated were male may have slightly skewed the results. The quality of life was also not evaluated. Conclusions In conclusion, postoperative defect repair of pharynx with a SF through the parapharyngeal space is a simple and feasible approach with sufficient tissue volume, minimal trauma, and a high success rate. It thus resolves the difficulty of repairing large wounds in the pharynx and reduces postoperative complications. This method is reliable and effective for postoperative defect repair of head and neck carcinoma, and it is worthy of widespread promotion. Abbreviations submental flap:SF balloon occlusion test: BOT internal carotid artery:ICA computerized tomography :CT Declarations Ethics approval and consent to participate: This retrospective study was approved and the informed consent (according to the declaration of Helsinki) was waived by the ethics committee of the Fifth Affiliated of Guangzhou Medical University, Guangzhou,Guangdong, China. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This study was supported by Guangdong Medical Research Foundation(A2024165). Authors' contributions: Xuirui Zhang : the first draft of the manuscript. Yaoxin Zhao: data acquisition, data analysis and manuscript editing. Yingqi Wang: statistical analysis, manuscript editing.Haiqiong Huang:definition of intellectual content, data acquisition.Huimin Ma: Guarantor of the integrity of the study, Literature research Huayong Hu:manuscript preparation, manuscript review and manuscript review. Jianzhong Zhang: study concepts,study design, definition of intellectual content. Acknowledgements: Special thanks to Professor Chen Mingyuan for his guidance of our research. References Siegel RL, Giaquinto AN, Jemal A: Cancer statistics, 2024 . CA: a cancer journal for clinicians 2024, 74 (1):12-49. Ostrowski P, Bonczar M, Gliwa J, Henry BM, Wojciechowski W, Walocha J, Koziej M: Topographic anatomy of the submental artery and its clinical implications for reconstructive surgery . Clinical anatomy (New York, NY) 2023. Ibrahim B, Rahal A, Bissada E, Christopoulos A, Guertin L, Ayad T: Reconstruction of medium-size defects of the oral cavity: radial forearm free flap vs facial artery musculo-mucosal flap . Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 2021, 50 (1):67. Wang D, Liao M, Wu J, Luo W, Qi S, Liu B, Li J: Salvage treatments for locally recurrent nasopharyngeal cancer: Systematic review and meta-analysis . Head Neck 2023, 45 (2):503-520. Feng Y, Dai Z, Yan R, Li F, Zhong X, Ye H, Chen C, Fan S, Qing C, Pan Y et al : Outcomes of Recurrent Nasopharyngeal Carcinoma Patients Treated With Salvage Surgery: A Meta-Analysis . Frontiers in oncology 2021, 11 :720418. Yang J, Song X, Sun X, Liu Q, Hu L, Yu H, Wang D: Outcomes of recurrent nasopharyngeal carcinoma patients treated with endoscopic nasopharyngectomy: a meta-analysis . International forum of allergy & rhinology 2020, 10 (8):1001-1011. Paydarfar JA, Kahng PW, Polacco MA, Zhao W: The submental island flap in head and neck reconstruction: A 10 ‐year experience examining application, oncologic safety, and role of comorbidity . Laryngoscope investigative otolaryngology 2022, 7 (2):361-368. Patel UA: The submental flap for head and neck reconstruction: Comparison of outcomes to the radial forearm free flap . The Laryngoscope 2020, 130 Suppl 2 :S1-s10. Ma H, Fang J, Zhong Q, Hou L, Feng L, He S, Wang R, Yang Y: Reconstruction of nasopharyngeal defect with submental flap during surgery for nasopharyngeal malignant tumors . Frontiers in surgery 2022, 9 :985752. Martin D, Pascal JF, Baudet J, Mondie JM, Farhat JB, Athoum A, Le Gaillard P, Peri G: The submental island flap: a new donor site. Anatomy and clinical applications as a free or pedicled flap . Plastic and reconstructive surgery 1993, 92 (5):867-873. FANG Jugao WR, ZHANG Jiamin: A pilot study to dissect the nasal pharyngeal cancer via a combined method of nasal endoscope and transparapharyngeal space . CHIN ARCH OTOLARYNGOL HEAD NECK SURG 2021, 28 (4):215-217. Forner D, Phillips T, Rigby M, Hart R, Taylor M, Trites J: Submental island flap 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 = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 2016, 45 :11. Ma H, Zhong Q, Hou L, Feng L, He S, Lian M, Zhao Y, Wang R, Fang J: Application of prolonged submental perforator flap to repair the postoperative defect of upper airway malignancy . European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies 2023. Sittitrai P, Ruenmarkkaew D, Kumkun C, Srivanitchapoom C: A retrospective propensity score-matched analysis of oncological and functional outcomes of submental island flap versus radial forearm free flap for oral cavity cancer reconstruction . BMC Oral Health 2024, 24 :1-12. Tahir MA, Qayyum MU, Umamah T, Tahir Y, Rubbab Z, Tahir M: Submental Flap as a Reconstructive Option for Reconstruction in Oral Cancer . Pakistan Armed Forces Medical Journal 2022, 72 . Song B, Kim HY, Jung YG, Baek CH, Chung MK, Hong SD: Endoscopic Debridement of Post-Radiation Nasopharyngeal Necrosis: The Effects of Resurfacing With a Vascularized Flap . Clinical and experimental otorhinolaryngology 2022, 15 (4):354-363. Jørgensen MG, Tabatabaeifar S, Toyserkani NM, Sørensen JA: Submental Island Flap versus Free Flap Reconstruction for Complex Head and Neck Defects . Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2019, 161 (6):946-953. Mooney SM, Sukato DC, Azoulay O, Rosenfeld RM: Systematic review of submental artery island flap versus free flap in head and neck reconstruction . American journal of otolaryngology 2021, 42 (6):103142. Kong F, Zhou J, Du C, He X, Kong L, Hu C, Ying H: Long-term survival and late complications of intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma . BMC cancer 2018, 18 (1):1139. Liu Q, Sun X, Li H, Zhou J, Gu Y, Zhao W, Li H, Yu H, Wang D: Types of Transnasal Endoscopic Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma: Shanghai EENT Hospital Experience . Frontiers in oncology 2020, 10 :555862. Fang C, Zhong Y, Chen T, Li D, Li C, Qi X, Zhu J, Wang R, Zhu J, Wang S et al : Impairment mechanism of nasal mucosa after radiotherapy for nasopharyngeal carcinoma . Frontiers in oncology 2022, 12 :1010131. Chang BA, Asarkar AA, Horwich PM, Nathan CAO, Hayden RE: Regional pedicled flap salvage options for large head and neck defects: The old, the new, and the forgotten . Laryngoscope investigative otolaryngology 2023, 8 (1):63-75. Lin HC, Huang YS, Chu YH, Liu SC, Shangkuan WC, Lai WS, Yang JM, Lin YS, Ma KH, Lee JC: Vascular anatomy is a determining factor of successful submental flap raising: a retrospective study of 70 clinical cases . PeerJ 2017, 5 :e3606. He SZ, Fang JG, Li PD, Zhong Q, Hou LZ, Ma HZ, Feng L, Chen XH, Shi Q: [Application of submental artery perforator flap in reconstruction surgery in pharyngeal carcinoma] . Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery 2020, 55 (12):1126-1130. Karimi E, Badiei R, Aghazadeh K, Sohrabpour S, Yazdani N, Dabiri S: Effect of Prior Radiotherapy on the Outcome of Submental Island Flap in Head and Neck Reconstruction . The Journal of craniofacial surgery 2018, 29 (7):1821-1824. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4592780","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":324473709,"identity":"d4e95dc6-33cf-4877-89e1-a439b4d0d84e","order_by":0,"name":"Xinrui Zhang","email":"","orcid":"","institution":"The Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou, Guangdong","correspondingAuthor":false,"prefix":"","firstName":"Xinrui","middleName":"","lastName":"Zhang","suffix":""},{"id":324473710,"identity":"16425f57-3aad-4c43-bf93-c70bd5fb5339","order_by":1,"name":"Yaoxin Zhao","email":"","orcid":"","institution":"The Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou, Guangdong","correspondingAuthor":false,"prefix":"","firstName":"Yaoxin","middleName":"","lastName":"Zhao","suffix":""},{"id":324473712,"identity":"33c9e8e7-9e32-451f-bc24-5d801ffc114e","order_by":2,"name":"Yingqi Wang","email":"","orcid":"","institution":"The Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou, Guangdong","correspondingAuthor":false,"prefix":"","firstName":"Yingqi","middleName":"","lastName":"Wang","suffix":""},{"id":324473713,"identity":"fb262f1b-abc3-4ec2-9fc3-9fec337a7836","order_by":3,"name":"Haiqiong Huang","email":"","orcid":"","institution":"The Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou, Guangdong","correspondingAuthor":false,"prefix":"","firstName":"Haiqiong","middleName":"","lastName":"Huang","suffix":""},{"id":324473716,"identity":"28daf723-0ebc-45f6-bada-402f1f885c2c","order_by":4,"name":"Huimin Ma","email":"","orcid":"","institution":"The Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou, Guangdong","correspondingAuthor":false,"prefix":"","firstName":"Huimin","middleName":"","lastName":"Ma","suffix":""},{"id":324473718,"identity":"e0b4b768-4a47-47c0-8d75-5af00b45992d","order_by":5,"name":"Huayong Hu","email":"","orcid":"","institution":"The Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou, Guangdong","correspondingAuthor":false,"prefix":"","firstName":"Huayong","middleName":"","lastName":"Hu","suffix":""},{"id":324473719,"identity":"95b26e1f-a592-4458-954d-32e6a07d1d5c","order_by":6,"name":"Jianzhong Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYBAC+/b+5x8+/pOQ42dvIFKLAc8ZNsYZbBbGkj0HiNUikcPGzMFWkWgwI4FILeYMucceM/BIJBhIPt54g6HGJpqgFsuGc+nGBRISeebSacUWDMfSchsI6jnYYCA9w0Ci2HJ2jpkEY8NhIrQcZjCQ5kmQSNxw8wyRWgyO8ZhJ8xwAarnBQ6QWyR62ZMOZDRLAQAb6JYEYv/DLPz744GNDHTAqD2+88aHGhgi/IDtSIoEU5RAtpOoYBaNgFIyCkQEAdRM+/cDCUOIAAAAASUVORK5CYII=","orcid":"","institution":"The Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou, Guangdong","correspondingAuthor":true,"prefix":"","firstName":"Jianzhong","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-06-17 08:29:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4592780/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4592780/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60600038,"identity":"da65371f-640b-4be9-bc7b-06a1df6c191d","added_by":"auto","created_at":"2024-07-18 16:00:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2098603,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4592780/v1/1c17800ddbb942f5ecc37b5d.png"},{"id":60600036,"identity":"a65ad3bb-8089-4b02-88dd-2cc9768e1e09","added_by":"auto","created_at":"2024-07-18 16:00:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1116553,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4592780/v1/4c401d23fb92eb8e1a9d6281.png"},{"id":63747073,"identity":"085a1da1-be79-4a84-97b0-cf0200def18d","added_by":"auto","created_at":"2024-09-02 02:31:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":6921451,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4592780/v1/81fdb7bd-da5b-4509-a605-366ae1512ce9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Repair defects after endoscopic debridement of head and neck cancer carcinoma with prior irradiation of submental flaps","fulltext":[{"header":" Background","content":"\u003cp\u003eA variety of surgical techniques have been designed to reconstruct defects left by cancer ablation[1]. Technological advancements made it possible to reduce the high morbidity and mortality by introducing less invasive techniques, such as endoscopic debridement of nasopharyngeal or oropharynx lesions, which could be used nasally, transorally, or orally. After radical surgery, postoperative defect will be broad and require tissue repair and reconstruction. The gold standard for reconstructing head and neck malignancies has been free tissue transfers, such as the radial forearm free flap[2]. These procedures are associated with a prolonged operating time and require extensive surgical team expertise, ultimately elevating costs for healthcare providers[3]. Furthermore, patients who have undergone head and neck chemoradiotherapy are at a higher risk of vascular anastomosis failure due to the use of micro-vascularized free flaps[4\u0026ndash;6].\u003c/p\u003e \u003cp\u003eSubmental flaps (SFs) have become a popular option in the fast-track surgery era for head and neck cancer. And there are also many benefits, including shorter surgery time, less resource-intensive postoperative care, color and texture resembling the head and neck, even specialized operating room equipment, personnel, postoperative care and advanced microvascular fellowship training are usually not required[7, 8].\u003c/p\u003e \u003cp\u003eWe have performed endoscopic debridement of oropharyngeal or nasopharyngeal lesions with previous irradiation, meanwhile the transcervical parapharyngeal space was exposed in the past few years. We have found that repairment with a local pedicl SF on the nasopharynx through the parapharyngeal space is reliable. The aim of this study was to evaluate the feasibility and effect of SF to repair the head and neck carcinoma with prior irradiation after endoscopic surgery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Clinical data:\u003c/h2\u003e \u003cp\u003eWe collected data from five patients, five of whom were male and ranged in age from 43 to 70 years, who underwent endoscopic debridement for nasopharyngeal or oropharyngeal lesions between 2022 and 2023 with the SF for post-operative reconstruction. Each of the five patients had received radiation therapy previously before surgery, neoplasm recurrence or radionecrosis was confirmed clinically and pathologically. Additionally, endoscopic findings, radiological studies, and clinical characteristics (such as headache and/or foul odor) were finished. In cases where the diseased tissue encircled the carotid artery, patients who tested negative for balloon occlusion test (BOT) underwent unilateral internal carotid artery (ICA) embolization; those who tested positive or negative for BOT underwent unilateral ICA embolization and had endovascular stent grafting implanted. Patients with pathology-confirmed negative results underwent debridement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Surgical methods.\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Endoscopic radical procedure\u003c/h2\u003e \u003cp\u003eEvery patient who was enrolled had an endoscopic radical operation. The lesion tissues were removed by wide debridement using low temperature plasma and a microdebrider, either with or without the assistance of an endoscopic drill. A frozen biopsy was subsequently conducted to rule out a positive operative margin. To prevent carotid artery rupture, great care was taken when debriding on the posterolateral side. Following debridement, we irrigated the area extensively with normal saline.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Preparation and design of SF\u003c/h2\u003e \u003cp\u003ePreoperative 0.5 mm thin-layer enhanced computerized tomography (CT) scans were performed on all patients, and CT venous images were continually scanned. The return vein was kept in the SF as per the preoperative CT prognosis, which was to confirm its presence. The root pedicle was prepared in the main body of the lesion on the ipsilateral side of the mental flap. The upper margin of the flap was designed along the lower margin of the mandible (0.5 cm from the mandible lower margin), extending from the lateral side of the submandibular gland on the pedicle side to the mandibular angle on the opposite side of the pedicle. The lower margin of the flap was situated between the thyroid cartilage and the hyoid bone in the median front of the neck. The skin, subcutaneous, and platysma muscles were cut and dissected on the surface of the facial artery at the mandibular angle in accordance with the intended flap.\u003c/p\u003e \u003cp\u003eThe marginal mandibular branch of facial nerve was dissected and protected; the anterior belly of the affected side's digastric muscle was severed at the chin to safeguard the flap vascular pedicle because of highly radiated tissues or necks devoid of vessels. The submental artery, which was shielded on the side of the chin flap, was located between the upper and lower margins of the submandibular gland and the jaw. The refluxing vein was verified by the preoperative CT scan and subsequently preserved in the SF. The submandibular gland was either removed or preserved at the base of the SF depending on how it related to the submental artery, reflux vein, and other structures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 SF repair the head and neck defects\u003c/h2\u003e \u003cp\u003ePay attention to the protection of the SF root (root torsion \u0026lt; 180°) and reconfirm the blood flow to the distal SF, and the epidermis at the proximal end of the preset submental flap was removed as appropriate to extend the pedicle. Additionally, the SF was flattened to completely cover the postoperative defects through the posterior medial angle of mandible-posterior pterygoid muscle-parapharyngeal space channel to the nasopharynx, or through anterior parapharyngeal space to the oropharynx, as well as the SF skin surface facing the pharyngeal cavity. The parapharyngeal space and SF were sutured in paraposition based on the positional relationship between the defects and SF. The nasopharynx defect was then filled with a gelatin sponge, which moderately compressed and fixed the SF on the nasopharynx. Finally, the porcine fibrin sealant kit was dripped onto the surface of the gelatin sponge. In every case, the subcutaneous skin is sutured layer by layer, a negative pressure drainage tube is positioned in the parapharyngeal space and neck, and a tracheostomy is planned.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Postoperative treatment\u003c/h2\u003e \u003cp\u003eThe patient was told to bend his neck as much as he could forward. On the SP pedicle, compression was not permitted. Oral hygiene was stressed, and symptomatic, anti-inflammatory therapy was given. Two days following the procedure, the postoperative MRI was examined in order to assess the effects of both the surgery and the SF blood supply.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThree of the five patients had necrotic and decaying materials from previous radiation therapy, two had tumor recurrence, and all five had negative incisive margins. An average of 6.8 hours were spent on the procedure, and 110 milliliters of blood were lost. About 16 days following the procedure, the patients were released from the hospital. After the procedure, the nasal packing was removed 10–14 days later. The average size of the SF used to repair the defects was 12–15 cm by 6–7 cm, and all of the flaps remained intact following surgery. Two weeks following the tracheotomy, the cannula was painlessly removed from each patient. Upon intraoperative evaluation, it was determined that all five patients had SF venous drainage, as well as nasal blockage and inadequate nasal ventilation as a result of the SF swelling after surgery. After the surgery, the SF progressively shrank and turned into a mucosal membrane with adequate ventilation three to six months later. During the follow-up period, no visible ulcer surface or dry scab formation was seen.\u003c/p\u003e\u003cp\u003eFive patients were followed up for 6–12 months till April 2024. No patient experienced a recurrence of nasopharyngeal or oropharyngeal carcinoma and cervical lymph node following the final operation throughout the 6- to 12-month follow-up period. Following surgery, the tracheal tube can be withdrawn, and the quality of the articulation is good.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThere are significant abnormalities in the head and neck following excision, and there is disagreement over the best way to manage postoperative wound complications, such as no repair, nasal mucosa flap repair, and temporalis muscle and free flap repair[9]. Following radiation therapy, a large number of patients with head and neck cancer have poor eating habits, chronic nutritional deficiencies, vascular sclerosis, and other poor vascular abnormalities. Vascular crises are most likely to occur in these people. For the reconstruction of big defects, the SF has become a more viable option than the free flap due to the presence of vascular deficient necks or severely radiated tissues. We tried to develop SF to fix head and neck cancer flaws from endoscopic surgery that had previously been exposed to radiation.\u003c/p\u003e\u003cp\u003eIn 1993, Martin et al first reported the anatomical and clinical characteristics of the submental flap (or submental island flap, submental artery island flap) [10]. Based on the submental branch of the facial artery and venous system, the flap has a thin, malleable thickness[11]. The patient's bodily condition determines the available skin size, which can vary greatly. The literature has recorded SF volumes as large as 22 cm–7 cm, and this volume is totally modifiable[12, 13]. For the majority of head and neck deformities, the SF has an excellent arc of rotation and a strong reconstructive result.\u003c/p\u003e\u003cp\u003eSince Martin et al introduced SF[10], it has a broad rotation arc and may reach defects in the upper airway[13], the oral cavity[14], oropharynx[15], nasopharynx[16], and skull base[4] et al. Previous research[8, 17, 18] has demonstrated that the application of SF for head and neck reconstruction has several benefits, such as being simple to harvest during the same surgical procedure, having flexible rotation and being close to sites of head and neck defects, resulting in less trauma and complications, a good quality of life following surgery, requiring less time and money than free tissue transfer without significantly affecting functional outcomes or complication rates, and having donor site scarring that can be easily hidden behind the mandible with good aesthetic effect.\u003c/p\u003e\u003cp\u003eIn this study, SF was mostly used to treat postoperative problems in individuals who had nasopharyngeal radionecrosis. To the best of our knowledge, there haven't been many reports of using SF for nasopharyngeal radionecrosis yet. In our investigation, the majority of the parapharyngeal constrictor muscles had to be excised in order to guarantee that the surrounding marginal tissues were effectively vascularized. Following the resection of nasopharyngeal radionecrosis, the defect measured 7–8 cm by 4–5 cm. After surgery, the local blood vessels and base bone of the skull may become exposed. This can result in intractable ulcers, local callus formation, necrosis, infection, and bleeding, all of which can have a serious negative impact on the quality of life of patien[19]. Therefore, for coverage and healing, the defect needs a tissue flap of the proper size.\u003c/p\u003e\u003cp\u003eBecause the nasopharynx is surrounded by bony structures, the nasal mucosa is the only nearby tissue that can be utilized [20, 21]. Nevertheless, the blood supply of the nasal septal valve was easy to be affected by nasopharyngeal malignant invasion, or nasal septum perforation occurred after radiotherapy and they are thin and relatively small, making these flaps unsuitable for the repair of large nasopharyngeal defects. Compared with nasal mucosa flaps, SF is an ideal and reliable repair material for nasopharyngeal defects with or without oropharyngeal defects [22]. The SF with the overlying skin can be used to repair the pharynx, and we used the posterior medial angle of mandible - posterior pterygoid muscle - parapharyngeal space channel to push the SF up to the nasopharynx, and anterior parapharyngeal space to push the SF up to the oropharynx. Additionally, the parapharyngeal space dissection and SF donor location are both done through the same incision, which makes the surgery less invasive, faster, and more convenient than other flap procedures.\u003c/p\u003e\u003cp\u003eWhen designing an SF, the reflux vein's path is unknown, but the submental artery's course for the SF blood supply is largely consistent[9, 23]. Because there are many variations in the submental vein returning to the proximal cardiac vein, the abnormal venous return also appears in the perioperative period of the mental flap. Thus, the primary cause of flap stasis necrosis is vascular crisis[9, 24]. This study used enhanced CT of the neck and preoperative thin slice scanning to anticipate venous return and misalignment. This information guided intraoperative mental regurgitation and significantly increased the rate of SF survival and manufacturing speed. When SP was constructed, the anterior belly of the afflicted side's digastric muscle was severed at the chin to safeguard the flap vascular pedicle. In all five of our patients, using an SF to repair was successful; no bleeding, infection, or local necrosis happened. Our findings appear to corroborate those of other researchers who have demonstrated the clinical utility and safety of the SF in individuals who have had prior neck radiation[7, 25].\u003c/p\u003e\u003cp\u003eThere is no doubt that this study has several shortcomings. This was a retrospective study with only five patients, a small sample size, and a brief follow-up period of 4–12 months. However, the fact that all of the instances that were evaluated were male may have slightly skewed the results. The quality of life was also not evaluated.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, postoperative defect repair of pharynx with a SF through the parapharyngeal space is a simple and feasible approach with sufficient tissue volume, minimal trauma, and a high success rate. It thus resolves the difficulty of repairing large wounds in the pharynx and reduces postoperative complications. This method is reliable and effective for postoperative defect repair of head and neck carcinoma, and it is worthy of widespread promotion.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003esubmental flap:SF\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; balloon occlusion test: BOT\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; internal carotid artery:ICA\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; computerized tomography :CT\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: This retrospective study was approved and the informed consent (according to the declaration of Helsinki) was waived by the ethics committee of the Fifth Affiliated of Guangzhou Medical University, Guangzhou,Guangdong, China.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: This study was supported by Guangdong Medical Research Foundation(A2024165).\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: Xuirui Zhang : the first draft of the manuscript. Yaoxin Zhao: data acquisition, data analysis and manuscript editing. Yingqi Wang: statistical analysis, manuscript editing.Haiqiong Huang:definition of intellectual content, data acquisition.Huimin Ma: Guarantor of the integrity of the study, Literature research\u003c/p\u003e\n\u003cp\u003eHuayong Hu:manuscript preparation, manuscript review and manuscript review. Jianzhong Zhang: study concepts,study design, definition of intellectual content.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: Special thanks to Professor Chen Mingyuan for his guidance of our research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSiegel RL, Giaquinto AN, Jemal A: \u003cstrong\u003eCancer statistics, 2024\u003c/strong\u003e. \u003cem\u003eCA: a cancer journal for clinicians \u003c/em\u003e2024, \u003cstrong\u003e74\u003c/strong\u003e(1):12-49.\u003c/li\u003e\n\u003cli\u003eOstrowski P, Bonczar M, Gliwa J, Henry BM, Wojciechowski W, Walocha J, Koziej M: \u003cstrong\u003eTopographic anatomy of the submental artery and its clinical implications for reconstructive surgery\u003c/strong\u003e. \u003cem\u003eClinical anatomy (New York, NY) \u003c/em\u003e2023.\u003c/li\u003e\n\u003cli\u003eIbrahim B, Rahal A, Bissada E, Christopoulos A, Guertin L, Ayad T: \u003cstrong\u003eReconstruction of medium-size defects of the oral cavity: radial forearm free flap vs facial artery musculo-mucosal flap\u003c/strong\u003e. \u003cem\u003eJournal of otolaryngology - head \u0026amp; neck surgery = Le Journal d\u0026apos;oto-rhino-laryngologie et de chirurgie cervico-faciale \u003c/em\u003e2021, \u003cstrong\u003e50\u003c/strong\u003e(1):67.\u003c/li\u003e\n\u003cli\u003eWang D, Liao M, Wu J, Luo W, Qi S, Liu B, Li J: \u003cstrong\u003eSalvage treatments for locally recurrent nasopharyngeal cancer: Systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eHead Neck \u003c/em\u003e2023, \u003cstrong\u003e45\u003c/strong\u003e(2):503-520.\u003c/li\u003e\n\u003cli\u003eFeng Y, Dai Z, Yan R, Li F, Zhong X, Ye H, Chen C, Fan S, Qing C, Pan Y\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eOutcomes of Recurrent Nasopharyngeal Carcinoma Patients Treated With Salvage Surgery: A Meta-Analysis\u003c/strong\u003e. \u003cem\u003eFrontiers in oncology \u003c/em\u003e2021, \u003cstrong\u003e11\u003c/strong\u003e:720418.\u003c/li\u003e\n\u003cli\u003eYang J, Song X, Sun X, Liu Q, Hu L, Yu H, Wang D: \u003cstrong\u003eOutcomes of recurrent nasopharyngeal carcinoma patients treated with endoscopic nasopharyngectomy: a meta-analysis\u003c/strong\u003e. \u003cem\u003eInternational forum of allergy \u0026amp; rhinology \u003c/em\u003e2020, \u003cstrong\u003e10\u003c/strong\u003e(8):1001-1011.\u003c/li\u003e\n\u003cli\u003ePaydarfar JA, Kahng PW, Polacco MA, Zhao W: \u003cstrong\u003eThe submental island flap in head and neck reconstruction: A 10\u003c/strong\u003e\u003cstrong\u003e‐year experience examining application, oncologic safety, and role of comorbidity\u003c/strong\u003e. \u003cem\u003eLaryngoscope investigative otolaryngology \u003c/em\u003e2022, \u003cstrong\u003e7\u003c/strong\u003e(2):361-368.\u003c/li\u003e\n\u003cli\u003ePatel UA: \u003cstrong\u003eThe submental flap for head and neck reconstruction: Comparison of outcomes to the radial forearm free flap\u003c/strong\u003e. \u003cem\u003eThe Laryngoscope \u003c/em\u003e2020, \u003cstrong\u003e130 Suppl 2\u003c/strong\u003e:S1-s10.\u003c/li\u003e\n\u003cli\u003eMa H, Fang J, Zhong Q, Hou L, Feng L, He S, Wang R, Yang Y: \u003cstrong\u003eReconstruction of nasopharyngeal defect with submental flap during surgery for nasopharyngeal malignant tumors\u003c/strong\u003e. \u003cem\u003eFrontiers in surgery \u003c/em\u003e2022, \u003cstrong\u003e9\u003c/strong\u003e:985752.\u003c/li\u003e\n\u003cli\u003eMartin D, Pascal JF, Baudet J, Mondie JM, Farhat JB, Athoum A, Le Gaillard P, Peri G: \u003cstrong\u003eThe submental island flap: a new donor site. Anatomy and clinical applications as a free or pedicled flap\u003c/strong\u003e. \u003cem\u003ePlastic and reconstructive surgery \u003c/em\u003e1993, \u003cstrong\u003e92\u003c/strong\u003e(5):867-873.\u003c/li\u003e\n\u003cli\u003eFANG Jugao WR, ZHANG Jiamin: \u003cstrong\u003eA pilot study to dissect the nasal pharyngeal cancer via a combined method of nasal endoscope and transparapharyngeal space\u003c/strong\u003e. \u003cem\u003eCHIN ARCH OTOLARYNGOL HEAD NECK SURG \u003c/em\u003e2021, \u003cstrong\u003e28\u003c/strong\u003e(4):215-217.\u003c/li\u003e\n\u003cli\u003eForner D, Phillips T, Rigby M, Hart R, Taylor M, Trites J: \u003cstrong\u003eSubmental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction: a case series and cost analysis\u003c/strong\u003e. \u003cem\u003eJournal of otolaryngology - head \u0026amp; neck surgery = Le Journal d\u0026apos;oto-rhino-laryngologie et de chirurgie cervico-faciale \u003c/em\u003e2016, \u003cstrong\u003e45\u003c/strong\u003e:11.\u003c/li\u003e\n\u003cli\u003eMa H, Zhong Q, Hou L, Feng L, He S, Lian M, Zhao Y, Wang R, Fang J: \u003cstrong\u003eApplication of prolonged submental perforator flap to repair the postoperative defect of upper airway malignancy\u003c/strong\u003e. \u003cem\u003eEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies \u003c/em\u003e2023.\u003c/li\u003e\n\u003cli\u003eSittitrai P, Ruenmarkkaew D, Kumkun C, Srivanitchapoom C: \u003cstrong\u003eA retrospective propensity score-matched analysis of oncological and functional outcomes of submental island flap versus radial forearm free flap for oral cavity cancer reconstruction\u003c/strong\u003e. \u003cem\u003eBMC Oral Health \u003c/em\u003e2024, \u003cstrong\u003e24\u003c/strong\u003e:1-12.\u003c/li\u003e\n\u003cli\u003eTahir MA, Qayyum MU, Umamah T, Tahir Y, Rubbab Z, Tahir M: \u003cstrong\u003eSubmental Flap as a Reconstructive Option for Reconstruction in Oral Cancer\u003c/strong\u003e. \u003cem\u003ePakistan Armed Forces Medical Journal \u003c/em\u003e2022, \u003cstrong\u003e72\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eSong B, Kim HY, Jung YG, Baek CH, Chung MK, Hong SD: \u003cstrong\u003eEndoscopic Debridement of Post-Radiation Nasopharyngeal Necrosis: The Effects of Resurfacing With a Vascularized Flap\u003c/strong\u003e. \u003cem\u003eClinical and experimental otorhinolaryngology \u003c/em\u003e2022, \u003cstrong\u003e15\u003c/strong\u003e(4):354-363.\u003c/li\u003e\n\u003cli\u003eJ\u0026oslash;rgensen MG, Tabatabaeifar S, Toyserkani NM, S\u0026oslash;rensen JA: \u003cstrong\u003eSubmental Island Flap versus Free Flap Reconstruction for Complex Head and Neck Defects\u003c/strong\u003e. \u003cem\u003eOtolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery \u003c/em\u003e2019, \u003cstrong\u003e161\u003c/strong\u003e(6):946-953.\u003c/li\u003e\n\u003cli\u003eMooney SM, Sukato DC, Azoulay O, Rosenfeld RM: \u003cstrong\u003eSystematic review of submental artery island flap versus free flap in head and neck reconstruction\u003c/strong\u003e. \u003cem\u003eAmerican journal of otolaryngology \u003c/em\u003e2021, \u003cstrong\u003e42\u003c/strong\u003e(6):103142.\u003c/li\u003e\n\u003cli\u003eKong F, Zhou J, Du C, He X, Kong L, Hu C, Ying H: \u003cstrong\u003eLong-term survival and late complications of intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma\u003c/strong\u003e. \u003cem\u003eBMC cancer \u003c/em\u003e2018, \u003cstrong\u003e18\u003c/strong\u003e(1):1139.\u003c/li\u003e\n\u003cli\u003eLiu Q, Sun X, Li H, Zhou J, Gu Y, Zhao W, Li H, Yu H, Wang D: \u003cstrong\u003eTypes of Transnasal Endoscopic Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma: Shanghai EENT Hospital Experience\u003c/strong\u003e. \u003cem\u003eFrontiers in oncology \u003c/em\u003e2020, \u003cstrong\u003e10\u003c/strong\u003e:555862.\u003c/li\u003e\n\u003cli\u003eFang C, Zhong Y, Chen T, Li D, Li C, Qi X, Zhu J, Wang R, Zhu J, Wang S\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eImpairment mechanism of nasal mucosa after radiotherapy for nasopharyngeal carcinoma\u003c/strong\u003e. \u003cem\u003eFrontiers in oncology \u003c/em\u003e2022, \u003cstrong\u003e12\u003c/strong\u003e:1010131.\u003c/li\u003e\n\u003cli\u003eChang BA, Asarkar AA, Horwich PM, Nathan CAO, Hayden RE: \u003cstrong\u003eRegional pedicled flap salvage options for large head and neck defects: The old, the new, and the forgotten\u003c/strong\u003e. \u003cem\u003eLaryngoscope investigative otolaryngology \u003c/em\u003e2023, \u003cstrong\u003e8\u003c/strong\u003e(1):63-75.\u003c/li\u003e\n\u003cli\u003eLin HC, Huang YS, Chu YH, Liu SC, Shangkuan WC, Lai WS, Yang JM, Lin YS, Ma KH, Lee JC: \u003cstrong\u003eVascular anatomy is a determining factor of successful submental flap raising: a retrospective study of 70 clinical cases\u003c/strong\u003e. \u003cem\u003ePeerJ \u003c/em\u003e2017, \u003cstrong\u003e5\u003c/strong\u003e:e3606.\u003c/li\u003e\n\u003cli\u003eHe SZ, Fang JG, Li PD, Zhong Q, Hou LZ, Ma HZ, Feng L, Chen XH, Shi Q: \u003cstrong\u003e[Application of submental artery perforator flap in reconstruction surgery in pharyngeal carcinoma]\u003c/strong\u003e. \u003cem\u003eZhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery \u003c/em\u003e2020, \u003cstrong\u003e55\u003c/strong\u003e(12):1126-1130.\u003c/li\u003e\n\u003cli\u003eKarimi E, Badiei R, Aghazadeh K, Sohrabpour S, Yazdani N, Dabiri S: \u003cstrong\u003eEffect of Prior Radiotherapy on the Outcome of Submental Island Flap in Head and Neck Reconstruction\u003c/strong\u003e. \u003cem\u003eThe Journal of craniofacial surgery \u003c/em\u003e2018, \u003cstrong\u003e29\u003c/strong\u003e(7):1821-1824.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"head and neck reconstruction, endoscopic surgery, submental flap, defect repair","lastPublishedDoi":"10.21203/rs.3.rs-4592780/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4592780/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e To explore the feasibility and effect of submental flaps to repair the head and neck carcinoma with prior irradiation after endoscopic surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study retrospectively analysed five cases with necrotic or recurrent of head and neck malignant tumours of post radiation after endoscopic surgery in our department from January 2023 to December 2023, including five males and aged 43–60 years. After endoscopic resection, the submental flap was prefabricated to repair the nasopharynx or oropharynx postoperative defects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAll cases in which flaps were used survived, and the average size of the SF used to repair the defects was 12–15 cm by 6–7 cm. All the patients had nasal feeding and the tracheal cannula was removed hospital discharge. Among them, patients with soft palate cancer repair had mild nasal reflux symptoms with smooth breathing. Upon intraoperative evaluation, all five patients had SF venous drainage, as well as nasal blockage and inadequate nasal ventilation. During the follow-up period 6–12 months, no visible ulcer surface or dry scab formation was seen.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions：\u003c/strong\u003eThis study features the use of a submental flap to repair the head and neck defects with prior irradiation after endoscopic surgery, and it is a simple and fast procedure with adequate tissue and good arteriovenous blood supply to adjacent sites. \u0026nbsp;This method is reliable and effective for postoperative defect repair of head and neck carcinoma, and it is worthy of widespread promotion.\u003c/p\u003e","manuscriptTitle":"Repair defects after endoscopic debridement of head and neck cancer carcinoma with prior irradiation of submental flaps","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 16:00:33","doi":"10.21203/rs.3.rs-4592780/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"48b9785e-1697-4cd1-9ee7-067e8fa58472","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-27T08:08:08+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-18 16:00:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4592780","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4592780","identity":"rs-4592780","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}