Submental artery island flap in intraoral reconstruction: A review

Background: The submental flap was first introduced 20 years ago (1993). Advances in techniques and new findings from anatomic studies expanded the indications and improved the flap characteristics. Indications, limitation, and all possible variants of this flap are discussed comprehensively in this article. Materials and methods: A literature review was performed. We paid attention to the anatomy of submental region, and especially to submental artery and vein, muscles and lymphatics. Surgical techniques for each possible variant of this flap and examples of each situation are presented. Indications of submental flap for facial, oesophageal, pharyngeal, laryngeal, and oral cavity reconstruction were assessed. Results: Ninety studies meeting the inclusion criteria were reviewed. Classification of the submental flap based on skin paddle composition and blood supply is presented. Major modifications such as pedicled, free, and perforator flaps are discussed comprehensively and minor variants of submental flap such as bipaddled, bipedicled, expanded, deepithelialized, and interposition submental flaps are discussed, briefly. A historical look at this topic is presented to show how and by whom advances in submental flap were done. Conclusion: The submental flap has a wide arc of rotation; it is easy to rise and has low donor site morbidity. It is a safe, simple, and predictable method for reconstruction of oral cavity. (c) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.