Abstract
Invasive surgery for geriatric patients with cancer increases the risk of severe complications even if it is indispensable for definitive therapy. The submental flap is a pedicled flap which is easy to harvest only in the cervical region, and does not require microvascular anastomosis and strict postoperative bed rest. We report two geriatric cases with advanced supraglottic cancer in whom this less-invasive flap was used for pharyngeal reconstruction after tumor resection.
The first case was an 89-year-old male with rT4aN0 cancer recurrence in epiglottic vallecula diagnosed 52 months after radiotherapy for cT2N0 epiglottic cancer. The second case was an 84-year-old male with cT3N2c primary epiglottic cancer. The histological type was squamous cell carcinoma in both cases. Extended total laryngectomy was applied to both cases due to tumor invasion of the tongue base and unilateral pyriform sinus. The pharyngeal defects in the first and second cases were successfully reconstructed with submental flaps measuring 8cm by 4cm and 11cm by 3.5cm, respectively. There was no significant postoperative morbidity other than a minor leak in the first case, and both cases were discharged 33 days after surgery. The first case died of local recurrence and cervical lymph node metastases 22 months after surgery, and he was able to consume a normal diet and utilize an electrolarynx until one month before death. The second case has been followed for 17 months after surgery with no disease.
These cases indicate that definitive surgery with reconstruction using the submental flap in the laryngopharyngeal region is practicable even in geriatric patients. Therefore, this less-invasive local flap would be a reasonable alternative to a free flap for pharyngeal reconstruction especially in vulnerable patients of advanced age with comorbidities.
