Functional Reconstruction of Glossectomy Defects: The Vertical Rectus Abdominus Myocutaneous Neotongue

Abstract

The vertical rectus abdominus myocutaneous (VRAM) flap is a valuable option for tongue reconstruction. However, the traditional inset (skin to remaining oral mucosa) obviates a more anatomic reconstruction. Eight patients underwent total or subtotal glossectomy with VRAM reconstruction. The muscle inset was supported at the inferior mandibular border attached to the remaining lingual mucosa or gingiva. The neotongue, consisting of skin and subcutaneous fat, was sutured posteriorly to the remaining tongue base, and the other surfaces were trimmed and left unsutured. Reconstruction was successful in all patients. The neotongue assumed palatal configuration, and within 2 weeks uniform granulation tissue followed by mucosalization occurred. One year postoperatively, all patients tolerated ad lib diets, spoke intelligibly, were gastrostomy tube and tracheotomy free and had no evidence of aspiration. This neotongue sits on the mandible under voluntary control, permitting effective obturation against the hard palate and providing successful speech and swallowing.

Total Glossectomy With Free Flap Reconstruction: Twenty‐Year Experience at a Tertiary Medical Center

“…2,18,19 There is no consensus on the ideal donor tissue for all types of repair, though generally it should be selected specific to the size of the defect and donor site availability on a case-by-case basis. 20,21 The differences in muscle/fat ratio specific to each flap may impact the long-term bulk and related functional outcomes; however, our head-to-head analysis between VRAM and ALT did not show any survival differences (Fig. 1B).…”

Total or subtotal glossectomy with microsurgical reconstruction: Functional and oncological results

“…These sutures allow the larynx to be projected up and frontward, occupying a more anatomical position. Other authors have followed this suggestion, 4,11,13,14,16,18 but radiographic studies have pointed out that larynx suspension is not essential for effective swallowing. 24 In manofluorography studies of patients treated with total glossectomy, Sultan and Coleman 15 demonstrated that the laryngo-hyoid complex suspension obtained with the flap was sufficient to achieve good functional results.…”

Indications, reconstructive techniques, and results for total glossectomy

“…11,14,23,24 Regarding dynamic functional flaps, in which a neural anastomosis is created between the hypoglossal nerve and a motor nerve of the transferred flap, current results are still controversial. Although reduced loss of muscle mass has been reported, 22,25 contractile function is usually insufficient when postoperative radiotherapy is prescribed, because radiotherapy-induced fibrosis hampers reinnervation. 17,26 Sensory reinnervation has been widely described after use of RFFFs to reconstruct hemiglossectomy defects.…”