The Submental Island Flap for Reconstruction of Maxillectomy Defects in the Elderly

Describing the use of the submental island flap (SMIF) for reconstruction for maxillectomy defects in elderly patients with regard to surgical and postoperative outcomes.

This retrospective single-center cohort study included patients > 70 years old (n = 8) with oral cavity cancers, treated between July 2017-December 2024. All underwent partial maxillectomy and SMIF reconstruction. Collected data included patient demographics, tumor characteristics, intraoperative details, time to oral diet initiation, and tracheostomy need. Main outcomes were perioperative and functional outcomes including operative time and oral diet initiation.

Among the eight identified cases: four patients were male and four female, with an average age of 83.0 years (SD 8.6). Primary tumor sites included the retromolar trigone (n = 1), buccal mucosa (n = 3), maxillary alveolus (n = 3), and hard palate (n = 1). Most tumors were stage T3/4 due to bony involvement, with an average size of 3.5 cm in the largest dimension (SD 0.8). Neck dissections were performed in all cases, with one patient having positive lymph nodes. SMIF sizes ranged from 4 × 6 cm to 15 × 8 cm. Average surgical time was 233.5 min (IQR 22.3-244.8) and tracheostomy was not required for any patients. All patients initiated an oral diet postoperatively, with time to oral nutrition ranging from 3 to 7 days (median 6.5 days, IQR 5.3-7).

The SMIF is a useful alternative for reconstructing maxillectomy defects in elderly patients. This series demonstrates early oral intake, avoidance of tracheostomy, and relatively short operative times, making it a promising option for patients ineligible for more complex reconstructive procedures.

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