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Purpose: Submental flap is gaining popularity for head and neck reconstruction. We have reported in 2007 our early experience of using submental flap for aggressive orofacial malignancy. Novel flap design and application is described in this updated series., Materials and Methods: 15 patients who had received submental flap reconstruction after extirpation of newly diagnosed aggressive orofacial lesions were retrieved. The details of the flap harvest was studied for flap size, inclusion of mylohyoid muscle, antegrade versus retrograde blood supply, and compared with our previous series., Results: The dimension of flap skin paddle was 30cm 2 (range 20-72). Retrograde pedicle flow was used in 2(13.3%) patients. Mylohyoid muscle was included in the flap in 6(40%) patients. There was no total flap necrosis while partial flap necrosis occurred in 1 patient(6.7%). There was a significant increase of inclusion of mylohyoid muscle to the flap in this series (p = 0.02). Novel techniques including double-paddled flap skin to resurface full-thickness defect and chimeric osteocutaneous mandible submental flap for maxillary defect were successfully performed., Conclusions: Submental flap is a viable reconstructive option in selected patients with aggressive orofacial malignancy. The indications are expanding and its technical modification is evolving and resulting in more innovative applications., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: Lymph node density(LND) has been shown to be a better prognosticator than conventional nodal classification to predict prognosis for squamous cell carcinoma(SCC) of the oral cavity. However, studies focusing on subsites of oral cancer are meager. The role of LND for buccal SCC was evaluated in this study., Methods: A total of 39 patients with buccal SCC primarily treated surgically with neck dissection were identified. LND was defined as the number of positive nodes over the number of nodal yield. The cut-off of LND was ≤0.07 or >0.07. Patient demographic data and clincopathologic parameters were described. Survival was expressed by Kaplan-Meier method and correlation with survival is analyzed with log-rank test. IBM SPSS Statistics version 22 was used for data computation., Results: The median follow-up was 79.0months and median nodes removed was 23 (range 8-93). Positive nodal involvement was found in 19(48.7%) patients. The 5-year and 10-year OS were 67.4% and 42.5% whilst for DSS were 69.2% and 65.5%, respectively. When pT-, pN-, LND-classification and AJCC stage were analyzed for the whole series, only pN- (p=0.006) and LND-classification (p=0.002) were significant factors for OS, while pT-, pN-, LND-classification and AJCC stage were all significant factors for DSS. When only cases with positive nodal spread were considered, the pN-classification (pN1 vs pN2) was not a significant risk factor for either OS (p=0.075, HR 3.10(CI 0.89-10.76)) and DSS (p=0.074, HR 3.58(CI 0.88-14.56)). By contrast, LND-classification (≤0.07 vs >0.07) remained a significant predictor for OS (p=0.03, HR 3.95(CI 1.15-13.63)), but not for the DSS (p=0.112, HR 2.92(CI 0.78-10.99))., Conclusion: The prognostic value of LND on buccal SCC is supported in this study. The results also suggest that LND is better than the conventional pN-classification to predict OS. Further studies on LND with big sample size for buccal SCC or other subsites of OSCC are worthwhile., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: Contralateral neck failure after therapy for squamous cell carcinoma of the oral cavity and oropharynx has rarely been studied in detail. We aimed to examine the pattern and outcome of contralateral neck relapse and possible predictive clinicopathologic factors., Patients and Methods: Seventy-three patients undergoing surgery for cancer of oral cavity/oropharynx with curative intent were recruited from the hospital head and neck cancer registry. The age, gender, tumor site, primary tumor laterality, TNM status, clinical N status, pathologic T status, ipsilateral pathologic N status, tumor stage, status of residual disease, histopathologic differentiation, postoperative radiotherapy, local relapse, distant relapse, extracapsular spread of lymph node metastasis and neck dissection were evaluated for association with contralateral neck relapse., Results: Seven patients developed ipsilateral, 5 patients developed contralateral, and 3 patients developed bilateral neck recurrence after therapy. Only 1 patient with contralateral or bilateral neck relapse survived after salvage therapy. Ipsilateral positive nodal status was the only significant clinicopathologic parameter associated with contralateral neck relapse, which occurred rather commonly in well-lateralized tumors., Conclusion: Contralateral and ipsilateral neck relapses are similar in occurrence. Pathologic positive nodal status is associated with a higher incidence of contralateral neck relapse. Aggressive and comprehensive adjuvant radiotherapy to the neck plus close surveillance in the first 2 years postoperatively might curtail the frequency and mortality due to contralateral neck failure.