Development and evaluation of a surgical 3D simulation model on submental flap surgery training.

OBJECTIVES: The purpose of the present study was to design and assess a 3D simulation model for submental flap surgery in training oral and maxillofacial surgery (OMFS) residents. METHODS: This quasi-experimental study involved a total of 20 OMFS residents attending and was conducted from September 2023 to December 2023. A 3D submental flap surgical phantom was designed using Mimics V.21 software and printed using fused deposition modeling technology. Participants were first tested on their knowledge of submental flap surgery before being randomly assigned to experimental or control groups. The experimental group received a lecture and demonstration using the developed phantom, while the control group had traditional lecture education only. Afterward, the same test was administered to all participants post-training. Pre- and post-test scores were calculated and compared between the two groups. p-Value < 0.05 was considered statistically significant. RESULTS: The average pre-intervention test scores in the control and experimental group, were 2.5 ± 1.43 and 3 ± 0.816, respectively (p = 0.35). Post-intervention, the experimental group exhibited significantly higher exam scores compared to the group who had only received academic lecture training (6.9 ± 0.87 vs. 4.9 ± 0.99) (p < 0.001). Irrespective of the applied teaching method, both groups showed a significant increase in exam scores after receiving submental flap training (p < 0.001 for both groups, paired-sample t-test). CONCLUSION: The use of the developed submental flap phantom model significantly improved OMFS residents' test scores and knowledge of the surgical technique, suggesting its potential integration into the conventional resident training curriculum.

Clinical application of V-shaped folded submental flap in the repair of oral defect. / Våž‹æŠ˜å é¢ä¸‹çš®ç“£ä¿®å¤å£è ”ç¼ºæŸçš„ä¸´åºŠåº”ç”¨.

OBJECTIVES: The repair of small and medium-sized defects in the oral has always been a challenge, free skin flap and distal pedicled tissue flaps are difficult to meet clinical needs, and the traditional under-chin flap has the risk of donor-area injury. This study aims to investigate the efficacy of V-shaped folded submental flap in the repair of small-sized and medium-sized oral defects. METHODS: The clinical data of 28 patients with oral defect lesions, who were hospitalized in the Department of Stomatology, Third Xiangya Hospital of Central South University from March 2019 to December 2022, were retrospectively analyzed. Patients were divided into a V-shaped folded group (17 cases) and a conventional group (11 cases) according to different surgical methods. The V-shaped folded group was treated with a V-shaped folded submental flap for postoperative soft tissue repair, while the conventional group was treated with a conventional submental flap for repair. The postoperative follow-up time was 6-48 months. The survival status, repair time, and repair effect of the 2 groups were compared. RESULTS: There was no significant difference in flap survival rate, flap size, flap preparation time, repair surgery time, and postoperative hospital stay between the 2 groups (all P>0.05). At 6 months after the surgery, the V-shaped folded group had no difficulty in raising the head or everting the lower lip, no "cat ear" deformity in the submental skin. Scars in the V-shaped folding group were hidden at the lower edge of the mandible. The wound aesthetics and functional scores in the V-shaped folded group were significantly higher than those in the conventional group (both P<0.05). CONCLUSIONS: The V-shaped foldable submental flap has the advantages of flexible design, simple preparation, reliable blood supply, and protection of the donor area, which can effectively protect the appearance of the chin and avoid functional disorders.

Submental Artery Island Flaps (SAIF) for Oral Cavity Cancer: Surgical Technique and Tertiary Care Experience.

In oral cancer surgeries, oncological outcomes take precious driverseat. But the copassengers like reconstruction, cosmesis, swallowing and speech outcomes deserve equivalent importance. Submental Artery Island Flaps (SAIF) provide an underutilized and extremely versatile option for reconstruction of defects following early stage oral cavity tumour resections. In this prospective observational analysis, we describe the technique, challenges and outcomes of SAIF at our tertiary care institute. Sixteen patients with Stage I and II oral cavity cancers were enrolled between June 2020 to May 2021. Verrucous carcinomas were five and well differentiated carcinomas were 11 patients. After tumour excision and neck dissections, defects were reconstructed with Pedicled submental flaps. Complications and functional outcomes were analyzed over two years. Nineteen percent were ladies and 81% were gentlemen. Median age was 52 years. Tongue tumours formed majority with 56% cases. Largest skin paddle taken was 36 cm2. Flap survival was 88%. There were variations in venous drainage of flaps which have been depicted in case figures. There was no report of orocutaneous fistula. Grade 3-4 speech satisfaction was achieved by 81.2% patients at 6 months. Swallowing was excellent, grade 4-5 for 100% of patients at 6 months. One patient had distant metastasis at 7 months and died. SRLR (Submental flap Recurrences) and trismus were zero percent at two years. The unexplored field of submental flaps can be used for oral cancer reconstructions in a versatile way. Donor site easy closures, no scars on face, early resumption of daily activities and short hospital stay makes it one of the ideal options in early stage oral cavity defects.

Desmoid fibromatosis-a diagnostic dilemma.

PURPOSE: Desmoid fibromatosis in head and neck is infrequent and poses a significant challenge to the clinicians due to its non-specific characteristics. METHODS: This case report focuses on a 69-year-old male who presented to a tertiary healthcare center in Karnataka, India with a swelling in the oral cavity. RESULTS: Despite initial suspicions of malignancy based on clinical examination and findings on computed tomography imaging, subsequent histopathology and immunohistochemistry revealed an unexpected finding. CONCLUSION: The case highlights the importance of clinical suspicion and histopathological evaluation as well as the need for greater awareness to facilitate early diagnosis and appropriate management of desmoid fibromatosis. We also present a literature review of varied presentations of desmoid tumors afflicting various subsites of the head and neck.

Submental island flap versus supraclavicular island flap in oral tongue cancer reconstruction: Perioperative and functional outcomes.

BACKGROUND: The primary treatment for oral tongue cancer in both early and advanced stages involves surgical resection, which often affects tongue function. When microvascular free flaps are unsuitable for tongue reconstruction following cancer ablation, locoregional pedicled flaps become viable alternatives, for example, submental and supraclavicular island flaps. This study compares perioperative and functional outcomes between submental and supraclavicular flaps in tongue cancer reconstruction. METHODS: This retrospective cohort study analyzed the outcomes of 46 patients who underwent tongue resection and reconstruction with a submental or supraclavicular island flap between January 2015 and December 2022. We evaluated patient demographics, flap outcomes, postoperative complications, and speech and swallowing outcomes. RESULTS: The study included 24 submental and 22 supraclavicular island flap reconstructions. While demographic data were similar between the two groups, the submental island flap group had significantly shorter operative times than the supraclavicular group (291 and 347 min, respectively, p = 0.018), reduced hospital stays (14.8 and 18.6 days, respectively, p = 0.016), fewer major recipient site complications necessitating interventions under general anesthesia (1 and 6 patients, respectively, p = 0.043), and less recipient wound dehiscence (1 and 8 patients, respectively, p = 0.009). Speech and swallowing outcomes were comparable in the two groups. CONCLUSION: The submental island flap appears to be a more favorable option for tongue reconstruction than the supraclavicular island flap, offering advantages in operative time, length of hospital stays, and lower rates of major complications and wound dehiscence.

Versatility of Submental Island Flap in N0 Neck in Oral Malignancies- A Retrospective Analysis of 50 Cases.

Submental flap is a gaining popularity as a reconstruction of orofacial defects in post-ablative defects, especially in situations where free flap services are not available or feasible. The background of this study was to demonstrate the oncological safety and benefits of this flap in oral cavity reconstruction. A retrospective analysis of 50 patients from the age group 28 to 70 years with oral cavity cancers of different subsites, who underwent submental flap reconstruction from 2018 to 2022 at our hospital for various ablative defects of oral cavity, were included in the study. We have reviewed the parameters like flap complications, post-operative mouth opening after 1 year and nodal recurrence. There were 37 males and 13 females patients in the study. 29(58%) patients had buccal cancers, 11(22%) patients had tongue cancer, 7(14%) patients had retromolar trigone cancer and 3(6%) had gingivo-buccal cancers. All patients underwent resection with ipsilateral selective neck dissection after flap was harvested. Complete flap loss was observed in 1(2%) patient, whereas as the flap dehiscence was seen in 3(6%) patients. Mean follow-up was 12 months. There were 3(6%) cases of nodal recurrence on the same side of flap after a mean time of 5 months of surgery. Inter-Incisal mouth opening was 20-30 mm in 68% of the cases. On the 1 year follow-up, all the patients were alive with no mortality. Oncologic outcome in terms of overall survival was found to be 94% in patients reconstructed with submental flap which makes it versatile for oral cavity reconstructions. Submental flap is a robust flap for oral cavity reconstruction. However, preoperative selection of clinically neck node-negative patient is extremely important as it has potential risk of occult metastasis and oncologic safety.

The Submental Flap for Reconstruction of Tongue Defects- Surgical Outcome and Quality of Life Assessment.

Tongue defects following resection of cancers, have a major effect on speech and swallowing, impairing the quality of life. Free flaps such as the free radial artery forearm flap and anterolateral thigh flap have been ideal for the reconstruction of such defects depending upon the volume of tissue loss. Local flaps such as the submental flap and pectoralis major myocutaneous flap serve as an alternative in decreasing morbidity and improving functional outcomes. Surgical outcomes associated with submental flaps used in the reconstruction of tongue defects were evaluated in our study. This is a retrospective analysis of 545 patients, where the submental flap was used for the repair of tongue defects for cancer resections. Oncological safety was studied in 375 patients with a median follow-up of 48 months. 140 patients were studied for their functional outcomes using the parameters, adapted from the University of Washington- Quality of Life questionnaire. Complete flap loss was seen in 15(2.75%) patients while 22(4.03%) patients had partial loss of flap. Locoregional Recurrences, second primary, and distant metastases were noted in 91 of the 375 patients studied. The mean score for swallowing, speech, and taste were 72,71, and 69 respectively. The submental flap is an effective and reliable alternative for the reconstruction of tongue defects. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03858-3.

The Utility of Sub-Mental Artery Island Flap for Reconstruction of Oral Cavity Defect After Oncological Resection: An Institutional Experience.

The submental artery island flap has been used for reconstruction of mild to moderate size oral defects after resection despite its controversy of oncological safety.Our study aims to assess the efficiency and oncological safety of submental artery flap in oral reconstruction.Twenty-three oral cancer patients who underwent resection and reconstruction using the submental artery island flap at State Cancer Institute, Guwahati, India, between February 2021 and February 2022 were retrospectively studied for the flap viability, complications, and function and locoregional recurrence.There were 9 men and 14 women with mean age of 58.56 years. The follow up period ranged from 7 months to 18 months with a median of 12 months. There was no loss of flap, i.e., 100% success rate of flap survival. One patient presented with locoregional recurrence at 11 months of follow up. Three male patients had hair growth on the flap inside oral cavity. There was one case of marginal nerve palsy and one case of donor site wound dehiscence which healed conservatively. The functions and donor site cosmesis were good in all the patients.Submental artery island flap is a good option for reconstruction in select cases of oral cancer.

Regional Flap Donor Sites in Head and Neck Reconstruction.

Regional flaps are vital to head and neck reconstruction, allowing surgeons to harvest numerous reliable flaps without the need for microvascular anastomosis. These flaps are very useful in cases of vascular depletion and may prove superior to free flaps as a primary option in certain circumstances. Numerous harvest options are available, and the described harvest techniques are safe and straightforward for an experienced reconstructive surgeon to learn. Donor site morbidity is variable depending on flap selection but minimal in many cases. Regional flaps are an excellent option in resource-limited settings or when minimizing reoperation is a high priority.

Oncologic safety of the pedicled submental island flap for reconstruction in oral tongue squamous cell carcinoma: An analysis of 101 cases.

OBJECTIVE: To evaluate whether the pedicle submental island flap (SIF) can be safely used in the oral tongue squamous cell carcinoma (OTSCC) patients with pathologically node-positive (pN+) neck, especially pN+ at level I. METHODS: Retrospectively, 101 OTSCC patients with SIF reconstruction were enrolled. Oncological outcomes included the total locoregional recurrence, the SIF related locoregional recurrence (SRLR) which referred to the local recurrence at flap and ipsilateral neck recurrence at level I, recurrence free survival (RFS), overall survival (OS), and disease specific survival (DSS). RESULTS: Sixty-one patients were pathologically node-negative (pN0) and 40 were pN+. Thirteen patients experienced locoregional recurrence, of which 5 had a SRLR. The pN+ group had a significantly higher locoregional recurrence rate, lower 5-year RFS, OS and DSS than pN0 group (P < 0.05). Patients with pN0 had a significantly higher neck RFS when compared to those with pN+ either at level I (P = 0.005) or at other levels (P < 0.001). However, the neck RFS was similar between the two subgroups of pN+ (P = 0.550). Especially, patients with pN+ at level I had a significantly higher SRLR rate (P = 0.006) compared to those with pN0 at level I. Multivariate analysis showed that pN+ was an unfavorable factor for tumor recurrence and OS. CONCLUSION: Our data did not support the use of SIF in OTSCC patients with pN+ neck at level I due to an significantly increased SRLR rate compared to those with pN0 neck at level I.

Versatility and aesthetic performance of the submental flap for reconstruction of skin defects in head and neck.

The submental flap (SMF) is a reliable option for head and neck reconstruction. It is a pedicle flap based on the submental artery and vein, divisions of the facial pedicle. The purpose of this Operative Technique is to describe the step-by-step setup of the submental flap for reconstruction of the preauricular region and to briefly examine its versatility and range of choices in skin and soft tissue defect reconstruction (see Supplemental video in the online version of the article). The harvesting of the SMF provides an aesthetically acceptable result for both the donor and reconstructed sites. The main advantages of the flap are its excellent color and texture match to the tissue in the cheek, and the possibility of restoring pilosity in male patients. In the opinion of the authors, the SMF is one of the best reconstructive alternatives for defects in the lower two-thirds of the face in elderly male patients.

Oncological outcome of contralateral submental artery island flap versus primary closure in tongue squamous cell carcinoma: randomized non-inferiority clinical trial.

The aim of this study was to test the non-inferiority of the contralateral submental island flap (CSIF) compared with primary closure (PC) regarding local recurrence after partial glossectomy in patients with oral tongue squamous cell carcinoma (OTSCC). This open-label, non-inferiority randomized controlled trial enrolled patients with cT1-2 lateralized OTSCC. The primary outcome was local recurrence by 12 months postoperative. Non-inferiority would be declared if the upper limit of the two-sided 95% confidence interval (CI) for the proportion difference in local recurrence between the two groups did not exceed a non-inferiority margin of 15.0%. The functional outcome was assessed for superiority through secondary outcomes. In the intention-to-treat analysis, the local recurrence rate was 3.1% (1/32) in the CSIF group versus 9.4% (3/32) in the PC group; the proportion difference was - 6.3% (95% CI -18.0% to 5.5%). In the per-protocol analysis, the local recurrence rate was 3.1% (1/32) versus 3.3% (1/30); the proportion difference was - 0.2% (95% CI -9% to 8.6%). Speech was significantly superior in the CSIF group (P = 0.001). In conclusion, the CSIF was found to be non-inferior to PC regarding local recurrence at 1 year. A limitation of this study is the relatively large non-inferiority margin and consequently relatively small sample size. Further studies with a smaller non-inferiority margin and therefore larger sample size are needed to validate these findings.

Rhino-oropharingeal osteoradionecrotic soft-tissue and bony defect reconstruction with submental artery island flap: a case report.

BACKGROUND: The submental artery island flap is widely used in head and neck reconstruction, since it is easy and quick to harvest, and it can be successfully used for the coverage of perioral, intraoral and facial defects. We used this technique for the reconstruction of a complex soft-tissue and bony defect of rhino-oropharinx. CASE REPORT: Osteoradionecrosis of rhino-oropharingeal posterior wall with C2 necrotic body exposure occurred in a 77-year-old woman. After the failure of reconstruction with a Hadad-Bassagasteguy flap, a submental island flap with cervical spine stabilization was planned to be performed in a one-stage operation. The anterior arc of C1 and odontoid process of C2 were removed and, according to the defect size, a submental island flap was designed in an elliptical fashion. The flap was rotated 180° and tunnelized under the left parapharingeal-prevertebral space, then it was positioned in the rhino-oropharinx and fixed with reabsorbable sutures. The donor site was closed primarily. No peri- or post-operative complications occurred, neither in the recipient nor in the donor-site. At the latest follow-up, 15 months postoperatively, the patient was able to speak without any impairment and started swallowing rehabilitation with good results and an aesthetically satisfactory outcome. CONCLUSION: The submental island flap may be a reliable and versatile flap for reconstruction of head and neck defects, even though in the rhino-oropharingeal posterior wall.

Facial-submental island flap for reconstruction of hemitongue defects in young, middle-aged and elderly patients with early and middle stage oral tongue squamous cell carcinoma.

BACKGROUND: This study evaluated the outcomes of facial-submental artery island flap (FSAIF) for reconstruction of the hemitongue following cancer ablation in patients with early and middle-stage oral tongue squamous cell carcinoma (OTSCC). METHODS: In total, 122 patients with early and middle-stage OTSCC were divided into young, middle-aged, and elderly groups. The Adult Comorbidity Evaluation-27 (ACE-27) index was used to determine the presence of comorbidities. The patients underwent surgical treatment with hemiglossectomy, neck dissection, and hemitongue reconstruction using FSAIF. In addition, stage I (n = 15) and II (n = 69) patients underwent ipsilateral selective neck dissection, whereas those with stage III (n = 38) underwent radical neck dissection. Six patients with T3N1 disease also underwent cobalt-60 adjuvant radiotherapy. RESULTS: Young and elderly patients exhibited significant differences in comorbidities, as assessed by the ACE-27 (p < .05). The skin paddles in the young, middle-aged, and elderly patients were 3 × 9 to 4 × 12 cm, 3 × 11 to 4 × 12, and 3 ×  10 to 5 × 13 cm in size, respectively. FSAIF failure occurred in four patients (success rate: 96.7%). No significant differences were observed in the skin paddle of the flap or rate of flap failure among the age groups (p > .05). Clavien-Dindo grades I, II, IIIa, IIIb, Iva, and IVb were assigned to 7.1, 36.1, 38.5, 9.8, 4.1, and 4.1% of the patients, respectively, with significant differences seen between the young and elderly patients (p < .05). In total, 52.5% of patients could eat normally, whereas 32.8% required a soft diet. Furthermore, 53.3 and 33.6% of patients achieved normal and intelligible speech, respectively. The aesthetic results were rated as excellent and good in 32.8 and 58.2% of patients, respectively. In total, 68.0% of the patients were alive and exhibited no evidence of disease, while 19.7% were alive with active disease. In addition, 12.3% of patients with stage III OTSCC died due to local recurrence or distant metastases. No differences in swallowing, speech, aesthetic, or survival outcomes were observed among the groups. CONCLUSIONS: FSAIF is a simple, safe, and reliable method for reconstructing hemitongue defects following cancer ablation in young, middle-aged, and elderly patients with early and middle-stage OTSCC.

Reconstruction of nasopharyngeal defect with submental flap during surgery for nasopharyngeal malignant tumors.

Objective: To investigate the feasibility and effect of a pedicled submental flap in postoperative defect repair of nasopharyngeal malignant tumors. Methods: Eight cases (six women, two men; age, 29-63 years) of postoperative defects after resection of malignant nasopharyngeal tumors with a lesion stage of (r) T1-3N0-2M0 were retrospectively analyzed. Preoperative enhanced thin-slice computed tomography of the neck was performed to predict the submental flap reflux vein. The submental flap was prefabricated during the operation, and the nasopharyngeal mass was removed through the parapharyngeal space approach combined with nasal endoscopy/mandibular external rotation/maxillary overturning. The submental flap was elevated to the nasopharyngeal defect area through the parapharyngeal space for repair. Results: Intraoperative examination confirmed that among the eight submental flaps, three had venous drainage into the internal jugular vein and five had venous drainage into the external jugular vein; these findings were consistent with the preoperative computed tomography findings. The size of the submental flap was 8-10 cm × 5-6 cm. The repair range reached the eustachian orifice on the healthy side and extended to the posterior wall of the maxillary sinus on the affected side. The flap extended to the posterior upper part of the nasal septum at the top, to the oropharynx at the bottom, and to the bony surface of the skull base at the deep side. Primary healing after surgery was achieved, and no flap necrosis occurred. After 3-77 months of follow-up, one patient with recurrent nasopharyngeal carcinoma after radiotherapy developed cervical lymph node recurrence again, one patient with adenoid cystic carcinoma had lung metastasis, and the remaining six patients had no recurrence. Conclusions: The pedicled submental flap is used to repair postoperative defects in the nasopharyngeal region through the cervical parapharyngeal space. It is a simple and fast procedure with adequate tissue volumes. The flap can effectively protect important structures such as the internal carotid artery and reduce the risk of infection and bleeding from postoperative wound exposure.

Tongue Reconstruction After Hemiglossectomy Due to Cancer by Submental Flap: A Case Series.

We report three clinical cases using a submental flap to reconstruct the half-tongue defects after tongue cancer surgery at Hue Central Hospital (Hue city, Vietnam). The size of the flap ranged 30-60mm. The time to take flap ranged 50-60 minutes. All three patients did not have liquid accumulation, wound infection and bleeding after surgery; the flap survived well. All patients were taken the nasogastric tube out after ten days and discharged after two weeks. Postoperative functional (speech, swallowing) and tongue aesthetic assessments (symmetry) were good. These cases highlight that the submental flap is a choice for patients with flaws in the tongue. It ensures both functional and aesthetic for the regenerative tongue and donor site.

[The application of submental flap in the nasopharyngectomy for nasopharyngeal carcinoma].

Objective:To explore the anatomy and clinical application of submental flap in the nasopharyngectomy for nasopharyngeal carcinoma. Methods:The anatomical study of the submental flap was carried out on 5 cadavers, focusing on exploring the channel of the submental flap transposition to the nasopharyngeal skull base area, and analyzing the nasopharyngeal skull base area covered by the submental flap. A retrospective analysis of 4 patients with submental flap repairment after nasopharyngectomy was performed, and the surgical methods and techniques of submental flap to repair nasopharyngeal nasal skull base defect were introduced in detail. Rusults: It showed that the submental flap could be transposed into the nasopharyngeal skull base through the posteromedial of the mandible-posterior pterygoid muscle-parapharyngeal space channel, and could cover the paraclival internal carotid artery. Clinical practice showed that the submental flap was successfully used to repair the nasopharyngeal skull base defect in 4 patients, and the submental flap grew well in the follow-up. Conclusion:The submental flap is suitable for the repair of the nasopharyngeal skull base defect after nasopharyngeal carcinoma surgery, and it is worthy of clinical promotion.

Quality of life in patients with cancer-related Brown IIb maxillary defect: A comparison between conventional obturation rehabilitation and submental flap reconstruction.

OBJECTIVES: The purpose of this retrospective study was to compare the differences in quality of life (QOL) outcomes between the conventional obturator prostheses (COP) and the pedicled submental artery island flap (SAIF) in the reconstruction of Brown IIb maxillary defects. MATERIALS AND METHODS: The QOL of 116 eligible patients who had a lapse ≥ 12 months after the cancer-related maxilla ablation was evaluated by the University of Washington quality of life scale (UW-QOL), Performance Status Scale for Head and Neck (PSS-HN), and Obturator Functioning Scale (OFS). RESULTS: Patients in the SAIF group reported statistically and clinically significant higher overall QOL scores but lower chewing scores in the UW-QOL scale when compared with those in the COP group (P < 0.05). Clinically significantly higher scores were also observed in the recreation and anxiety domains in the UW-QOL scale for the SAIF group, but there was no statistical significances. The COP group reported more complaints about the nasal leakage when swallowing and the shape of the upper lip, and had a stronger willingness to avoid family or social events in the OFS (P < 0.05). CONCLUSIONS: For patients with Brown IIb defects, SAIF reconstruction can achieve reduced nasal leakage when swallowing, improved upper-lip contour, increased social activity, and superior overall QOL than COP. The inferior chewing function in the SAIF group indicated the need for dental rehabilitation with a conventional denture or osseointegrated implants.

Anatomic Variation of Submental Artery: A Case of Submental Artery Coursing Through a Developmental Defect of Mylohyoid Muscle.

Knowledge about variations in mylohyoid muscle and submental artery is essential for maxillofacial surgeons, as these structures are commonly encountered in maxillofacial ablative and reconstructive surgery. While cadaveric and radiologic studies on mylohyoid variations have been documented in the literature, we report an intraoperative variation observed in relation to mylohyoid muscle and submental artery.

Reverse Facial-Submental Artery Osteomyocutaneous Flap, a Novel Choice for Previously Operated Huge Alveolar Clefts.

Adult previously operated alveolar cleft palate presents a pronounced challenge for optimal surgical reconstruction. This optimal reconstruction dictates the restoration of soft tissues in addition to hard tissues to achieve prime functional results. Regional flaps usually used for the reconstruction of such defects were considered as either bulky or none bone bearing flaps. Furthermore, using free flaps for reconstruction can rise the concerns of increased intraoperative complications and greater suspected donor site morbidities. Here we present three unfavorably previously operated patients with current huge alveolar cleft palates, planned for the reconstruction with reverse facial-submental artery osteomyocutaneous flap. Besides, detailed flap harvesting technique, results, prosthetic restoration post to flap surgery, and follow up are presented in this article. We found the reverse facial- submental osteomyocutaneous flap as a novel and reliable choice for functional reconstruction of challenging huge alveolar cleft palates. The reverse facial-submental flap has not been yet mentioned in the medical literature for the reconstruction of alveolar clefts.