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Background: The submental flap is a pedicled island flap with excellent colour match for facial reconstruction. The flap can be raised with muscle, submandibular gland or bone and can be transposed to reach defects up to two thirds of the face. We report the primary author's experience of 25 years using the submental flap from its original description to most recent technical evolutions in both Europe and Africa. Methods: This is a retrospective study including all patients with facial defects reconstructed using a submental flap between 1991 and 2016. This study included the use of all four variations of the submental flap: "platysmal', "digastric", "extended" and "super extended". We report technical adaptations and complications encountered. Results: We performed 311 facial reconstructions using submental flaps: 32 "platysmal", 133 "digastric", 91 "extended" and 45 "super extended" variations. In conjunction with these reconstructions, we performed 10 osteocutanous submental flaps and 2 free flaps. We report 2 cases of total flap necrosis (0.6%) and 28 minor complications including: 23 cases of distal skin necrosis (7%), 1 reversible mandibular facial nerve palsy (0.3%) and 3 hematomas (1%). Conclusions: The submental flap has proven to be a reliable flap for head and neck reconstruction. The four technical modifications described employ varying amounts of soft tissue to replace tissue lost and can include vascularized bone from the mandibular margin. This flap exemplifies Gillies' principle of "replacing like with like" and should be discussed as an alternative to free tissue transfer in facial reconstruction, especially in settings where resources are limited.

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\ois-XavierMichelet, MD \s=b\Fifteen patients underwent surgery for retromandibular parotid, pharyngeal, or posterior tongue tumors. Surgical approach to the pterygomaxillary fossa, parapharyngeal space, and posterior tongue was performed by external cervical incision and lateral stair-step mandibulotomy. After resection of the tumors, the mandibular segments were replaced and secured with miniplates. The plates were removed after six weeks whenever postoperative radiation therapy was planned. By reflecting the ascending ramus, this method provides excellent exposure of the concerned areas. It makes unnecessary both incision of the lower lip and intermaxillary fixation with arch bars, thus allowing a quick resumption of oral feeding. A review of 15 patients demonstrated satisfactory results for mandibular function and morphologic appearance, with minimal complications.

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