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Free vastus lateralis flaps for maxillofacial reconstruction were used in 30 patients. On the basis of its anatomy, this flap can be inserted as a musculocutaneous or musculofascial transplant in slim or normal-weight patients if extensive defects exist. The microvascular transfer is facilitated and accelerated by the long and high-caliber vascular pedicle and flap raising, which can be performed at the same time as tumor resection. We see indications for the musculocutaneous transplant in almost all sections of the oral cavity, particularly for tongue reconstruction; the vastus lateralis flap can be inserted in a purely muscular form for defect coverage on the scalp in connection with split skin. The donor defect is minimal functionally and aesthetically, and the success rate is approximately 90% for all flap transfers.

Received October 16, 2010 Revised January 4, 2011 Accepted January 12, 2011 Address for correspondence J. Hun Hah, MD Department of Otorhinolaryngology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea Tel +82-2-2072-0215 Fax +82-2-745-2387 E-mail jhunhah@snu.ac.kr Reconstruction with free flaps has become the choice of reconstruction for most patients with head and neck defects. However, pedicled flaps, such as pectoralis major pedicled flap and latissimus dorsi pedicled flap (LDPF), can also be used instead in selected patients. We performed LDPFs in 6 patients from November 2007 to September 2009. Five of the patients were females with either vascular diseases or large skin defects, or they were highrisk old patients. One male patient received LDPF as a salvage after tongue reconstruction with a free flap failed. Various types of head and neck defects were effectively managed with LDPF without complications. LDPF can be one option for head and neck reconstruction especially in patients who may hve high risk in undergoing free flap reconstruction. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:174-8 Key WordsZZLatissimus dorsi flap ᆞPectoralis major myocutaneous flap ᆞPedicled flap ᆞ Free flap reconstruction.

The lateral vastus muscle flap has the potential to become one of the most appropriate free flaps for reconstructive surgery in the oral maxillofacial area in selected cases. The flap is relatively easy to harvest and gives rise to little donor site morbidity. The quality of the large diameter vessels allows for relatively easy microsurgical anastomosis. Nerve anastomosis is possible, which makes it extremely suitable for tongue reconstruction.

Acoustic characteristics of sibilant sounds produced by 17 Canadian English‐speaking female (6 patients) and male (11 patients) tongue cancer patients were studied. The patients had undergone a tongue resection of the anterior 2/3 of the tongue, and tongue reconstruction with a radial forearm free flap (RFFF). The acoustic data included measurements of the spectral moments (mean, standard deviation, skewness, and kurtosis) of sibilants /s, z/ analyzed from speech samples (stimulus sentences and Zoo Passage) which were recorded before the tongue resection, and 1 month, 6 months, and 12 months after the resection with RFFF reconstruction. Primarily, the tongue reconstruction with RFFF was found to result in temporary changes on the spectral characteristics such that speech output was found to approach the pre‐operative speech quality over the 1‐year period. In addition, RFFF reconstruction of the tongue was found to have some gender‐specific effects in the acoustic characteristicsanalyzed. However, there was variability between patients, indicating individual compensatory and adaptive mechanisms for the altered sensorimotor function of the tongue following tongue reconstruction with RFFF. [The protocol for this study has been approved by the Health Research Ethics Board (HREB) of the University of Alberta (Edmonton, AB, Canada).]

Total or subtotal tongue resection results in the potential for severe speech and swallowing disruption and life-threatening aspiration. This report documents the development of a new design for latissimus dorsi flaps used in tongue reconstruction. In order to create a contractile muscle sling which will raise the neotongue toward the palate for speech and swallowing, the flap is harvested with muscle fibers oriented transverse to its long, skin component axis. The flap is then transferred to the oral and oropharyngeal defect and sutured at the level of the mandibular angle to the remaining muscles of mastication. Conventional microvascular anastomosis for free flaps is followed by end-to-end reanastomosis of the hypoglossal nerve stump to the nerve to latissimus dorsi. The skin component is set into the floor of mouth with a curved wedge resected anteriorly, raising a mound to assist with articulation. Fourteen such reconstructions have been performed on patients undergoing glossectomy for cancer. If not invaded by cancer, the glottic larynx was preserved, and the decannulation rate was 80% at a median postoperative interval of 3.2 weeks. Seventy percent of patients achieved oral intake with pureed food or better, and upward motion of the flap was documented by video swallowing studies. Articulation was particularly good. This innervated latissimus dorsi flap design therefore is a viable method for rehabilitation after total or subtotal glossectomy.

Twelve patients have been studied for speech and swallowing function after major combined jaw and tongue reconstruction with the microvascular iliac bone and groin skin composite flap. Cinegraphic barium swallows demonstrated that for bolus propulsion, it is important to be able to occlude the palate with the flap. Glottic competence prevents aspiration. Speech studies show that although there is loss of certain speech sounds, approximate sounds are substituted. Speech is intelligible when soft-tissue contact to the palate can be accomplished. The adaptive mechanisms in these patients have been compared with the mechanisms used by a patient with uncorrected congenital aglossia and hypomandibulosis who developed excellent speech and swallowing. The mobility of this patient's mouth and pharynx was similar to that in the reconstructed cancer patients who were able to swallow and speak. This procedure has become our reconstruction method of choice for these major defects.

Total glossectomy is the most crippling of all oral cavity resections. Speech problems are unavoidable and post-operative aspiration is often severe. Two patients are presented who have had tongue reconstructions following near-total glossectomies. In each case a quilted, split-skin grafted pectoralis major muscle flap was used. The speech and swallowing results of these two patients are compared with two patients who underwent a hemiglossectomy and total glossectomy respectively without tongue reconstruction. Only if the suprahyoid and extrinsic tongue muscles are preserved can an active oral phase of swallowing and usable speech be regained by tongue reconstruction.

The pectoralis major myocutaneous flap has been used for the reconstruction of defects incidental to resection of tumors in the oral cavity in five patients.The thoracoacromial artery runs just lateral to the mid portion between the sternoclavicular joint and the acromion after originating from the axillary artery. Although arteriographic visualization of the entire muscle arborization is not possible, arteriography is required before surgery for identification of the major blood supply to the muscle.The result of postoperative X-ray cinematographic analysis of the tongue movement is closer to normal as compared to that of simple removal. Likewise postoperative speech was also closer to normal compared with that of simple removal.

Hemiglossectomy defects need reconstructions to restore normal functions and aesthetic outcomes. It is therefore prudent that well-planned reconstructive technique is needed for a good functional substitution for the defect.This case report describes a 30 years old male who developed T2N1M0 squamous cell carcinoma of the left tongue. The patient underwent a tongue reconstruction following his hemiglossectomy involving floor of the mouth without mandibular resection.The optimum method of reconstructing a major defect such as hemiglossectomy with floor of the mouth resection is best carried out by using microvascular free tissue transfer. We conclude that the radial forearm free flap is good method for reconstructing major defects of the tongue. The radial forearm free flap is thin, can be raised without patient position change, has constant vascular anatomy, and provides an advantage in the aesthetic aspect at the donor site.