[The pedicled submental flap].

INTRODUCTION

Facial reconstruction technique can be simple or complicated. The choice of performing a flap is made according to several criteria. Since its first description the submental flap has been used in several indications. The aim of this article was to document maxillofacial surgeons on this flap technique.

ANATOMY: The submental artery is a major branch of the facial artery. This artery runs medial to the mandible and ends next to the mandibular symphysis. The submental artery supplies the submandibular lymph nodes, submandibular salivary gland, mylohyoid and digastric muscles, and the skin of the chin. The submental vein drains the tissues of the chin as well as the submandibular region.

TECHNIQUE: The integrity of the facial artery is a sine qua none condition before performing this flap. It is important that the submandibular gland and the submental vessels be well exposed. The anterior belly of the homolateral digastric muscle must be included in the flap. The donor side is closed after a large subcutaneous dissection of the neck and chin.

INDICATIONS: The pedicled submental flap is indicated in defects of the oral cavity and the lower two-thirds of the face.

ADVANTAGES: The submental flap is relatively easy to raise. This flap avoids dyschromia and provides soft-tissues presenting with the same quality as that of the tissue surrounding the defect. Sequels on the donor side are minor.

DISADVANTAGES: The submental flap is not indicated if a submental neck dissection is needed or in case of intraoral/frontal reconstruction with bearded skin. The submental flap is a simple and reliable procedure, with good aesthetics results and minor sequels.