Outcomes of folded submental flap reconstruction for full-thickness cheek defects in advanced oral cavity cancer

OBJECTIVE: Full-thickness cheek defects resulting from advanced oral cavity cancer pose significant reconstructive challenges, with both functional and aesthetic implications. Although free flap remains the gold standard, it is resource-intensive. This study evaluates the folded submental flap as a practical alternative. METHODS: A retrospective review was conducted of eight patients with oral cavity cancer who underwent submental flap reconstruction between January 2017 and September 2024 at a single tertiary center. Clinical outcomes and complications were analyzed, and aesthetic and functional results were assessed through physical examination and a validated five-parameter scoring system. RESULTS: Eight male patients (mean age: 51.3 years) with full-thickness cheek defects underwent folded submental flap reconstruction. Defect measured 4 × 3 - 8 × 6 cm, flap sizes 9 × 5 - 13×7 cm. Mean operative time was 408 minutes and average hospital stay 17 days. Two minor complications (salivary leakage, wound dehiscence) resolved without sequelae. No flap loss, donor-site morbidity, or locoregional/nodal recurrence occurred during a mean follow-up of 23.8 months. Six patients remained disease-free, one died of distant metastasis, and one of unrelated causes. Functionally, all resumed oral intake prior to discharge, and seven retained clear speech and full mouth opening. Aesthetic assessment showed high satisfaction and mean scores of 8.1-9 across all five parameters. CONCLUSION: The folded submental flap provides a reliable, functionally effective, and aesthetically favorable reconstructive option for full-thickness cheek defects. It represents a resource-efficient alternative to free flaps in appropriately selected oral cavity cancer patients.