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Submental flap for vascularized lymph node transfer; a CTA-based study on lymph node distribution.

Vera A A Paulus1, Harm Winters1, Stefan Hummelink1

  • 1Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.

Journal of Surgical Oncology
|July 16, 2020
PubMed
Summary

The submental flap offers a low risk for lymphedema. Computed tomography angiography (CTA) reveals variable lymph node distribution along the mandible, aiding surgical planning for vascularized lymph node transfers.

Keywords:
VLNTlymphedemasubmental lymph nodesupper extremity

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Area of Science:

  • Anatomy
  • Radiology
  • Surgical Oncology

Background:

  • Vascularized lymph node transfer is a reconstructive surgical technique.
  • The submental flap is a preferred option due to its low risk of causing iatrogenic lymphedema.
  • Understanding lymph node anatomy is crucial for optimizing this procedure.

Purpose of the Study:

  • To investigate the distribution, number, and size of lymph nodes in the submental and submandibular regions.
  • To utilize computed tomography angiography (CTA) for detailed anatomical mapping.
  • To inform surgical planning for submental flap-based lymph node transfers.

Main Methods:

  • Retrospective analysis of 52 head/neck CTA scans.
  • Identification and recording of lymph nodes in the submental and submandibular areas.
  • Standardization of lymph node data using a 3D coordinate system and iterative closest point algorithm.

Main Results:

  • An average of 5.3 lymph nodes were identified, with a mean size of 5.28 mm.
  • The average distance from lymph nodes to the submental artery origin was 25.53 mm.
  • No significant differences in lymph node size, number, or distance were observed between the left and right sides, or between genders.

Conclusions:

  • Lymph node distribution along the mandible exhibits significant variability.
  • Preoperative CTA scans are recommended to precisely map lymph nodes.
  • This mapping can help maximize the number of transferred lymph nodes and refine submental flap design for improved outcomes.