Twelve Years of Establishing the Strategies for Tongue Reconstruction

Abstract

Background Reconstruction after resection of malignant tongue tumors remains one of the most difficult problems in head and neck oncology. Recent trends in tongue reconstruction have focused on optimizing speech and swallowing functions and maximizing quality of life. In the recent literature, several reconstructive strategies including regional flaps and free flaps have been described. Patients and Methods A case series of 328 patients underwent oral tongue reconstruction between March 2011 and March 2022. Functional evaluation was performed in all patients 3 months after reconstruction (where the patients required no adjuvant radiotherapy) or after radiotherapy. Results Total flap necrosis was seen in 5 patients with free flap reconstruction (2 radial forearm flaps, 1 lateral arm flap, and 2 anterolateral thigh flaps), 5 patients with infrahyoid myocutaneous flap, and 1 patient reconstructed with a supraclavicular flap. Our success rate is 96.6%; partial flap necrosis was observed in 11 patients with infrahyoid myocutaneous flap and 2 patients with a supraclavicular flap. Most patients with subtotal glossectomy or smaller defects (type II–IVA defects) could communicate on the phone and had the near-normal capacity for an oral diet. The remaining patients (type IVB–V defects) had significantly lower speech scores. The majority of patients could eat liquid and semiliquid foods. Conclusion Tongue cancer surgery and subsequent reconstruction posed exciting challenges for the surgeon to optimize tongue function and quality of life for patients. Attention to the principles of tongue reconstruction and choosing appropriate flap for each defect achieve better functional results.

Aesthetic Considerations of Simultaneous Reconstruction With Free Flap for Local Advanced Hypopharyngeal Combined With Cervical Esophageal Cancer

“…The thickness requirements of the flap for reconstruction of different anatomical parts of the head and neck vary greatly to a certain extent. For certain anatomical defects, such as the posterior pharyngeal wall, soft palate, pyriform sinus, and cervical esophagus, thinner skin flaps are required, which is conducive to the placement, curling, and ensuring sufficient space for the repaired anatomical structure; however, tongue reconstruction requires that the reconstructed tongue volume be large enough with more fat and less muscle, which will result in minimal postoperative significant shrinkage of the tongue volume in the long run, to meet the functional requirements of squeezing food into the pharyngeal cavity 7 . Therefore, to reconstruct a spacy pharynx or esophagus, precise surgical steps are required to reduce the thickness of subcutaneous fat of the flap 8 .…”

Twelve Years of Establishing the Strategies for Tongue Reconstruction

“…We have read with interest the article “Twelve Years of Establishing the Strategies for Tongue Reconstruction” by Nguyen 1 …”