Submental island flap reconstruction for carcinoma of the oral cavity: Experience in 30 cases

Objective:The submental flap can be utilized for soft tissue reconstruction in oral cavity malignancies because due to its close approximation to the surgical site,fewer donor site morbidity and the cost effectiveness of the procedure.Methods:A total of 30 patients with squamous cell carcinoma of the oral cavity were included in the study from July 2012 to August 2015 in a tertiary care referral hospital.Patients with clinical staging Ⅰ/Ⅱ/Ⅲ (T1/T2/T3,N0) oral malignancy were included in the study.Patients with nodal metastasis irrespective of the stage of disease and patients with chronic medical illness/revision cases were excluded from the study.Submental island flap was utilized for the reconstruction of the soft tissue defect in each patient.Patients were followed at monthly interval till 6 months in the postoperative period.Results:The buccal mucosa (12 patients),tongue (10 patients) and floor of mouth (8 patients) were the subsites in the oral cavity.Partial and complete skin necrosis was found in 4 and 2 patients respectively.Postoperative chemoradiation was required in 5 patients.None of the patients had loco regional recurrence till 6 months of follow-up.Conclusion:The submental island flap is considered to be the reliable option for the soft tissue reconstruction in oral cancer because of dependent vascular pedicle,less donor site morbidity and the lower cost compared to the free flaps,often preferred in patients with a lower socioeconomic condition.

Surgical management of extracranial nerve sheath tumours in a tertiary care center

Objective:Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structures.Methods:It is a retrospective study contained 13 consecutive patients of nerve sheath tumours involving the head and neck from March 2013 to February 2017 in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care referral hospital The retrospective clinical data,diagnostic procedures,surgical approaches and their complications are analyzed after 12 months of surgery.Results:Total 13 patients,7 were females and 6 were males.Painless neck swelling was the most common presentation found in 6 and the most common site of origin was the vagus nerve in the parapharyngeal space (6 patients).Transcervical excision of the tumour was performed in 7 patients.Six needed combined surgical approach for the excision of the tumours.Neurovascular injury was detected in 3 patients,and one patient had recurrent disease during the follow-up period.Conclusions:Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structure.Although the transcervical approach is commonly practiced for the majority of the tumours,combined approaches can be effectively applied for extensive nerve sheath tumours with the satisfactory clinical outcome.