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Oral squamous cell carcinoma (OSCC) is a leading cause of cancer-related deaths in developing countries. The oral tongue is the most common site involved by OSCC. About one-third of the patients have neck nodal metastasis at presentation. Oral tongue reconstruction after resection for cancer is necessary for proper rehabilitation. For patients who are medically unfit for prolonged surgery like a free tissue transfer, local flaps are employed for tongue reconstruction. The submental flap is a popular option. However, when there is an extensive floor of mouth involvement or bulky nodal disease in ipsilateral level 1, submental flap harvesting based on contralateral facial vessels is possible without compromising oncological safety. This study discusses the feasibility and outcomes of contralateral submental artery island flap (SMIF) for reconstruction after resection of oral tongue carcinoma in a retrospective series of 34 patients followed up for a median of 8.5 months. Of the 34 oral tongue cancer patients in the study, 16 had neoadjuvant chemotherapy before surgery. Thirty-three underwent bilateral neck dissection. Two patients had partial flap loss, which was managed conservatively. Five patients had either locoregional or distant recurrence, but none in the flap site. Three had pathological positive nodes at ipsilateral level 1b, and one had pathologically positive nodes at contralateral level 1b. Tongue motility and speech intelligibility were satisfactory on follow-up. In the properly selected patient, contralateral SMIF offers an oncologically safe and technically simpler alternative for free flap reconstruction. [ABSTRACT FROM AUTHOR]

Introduction. Surgery is the leading treatment for tongue cancer, performance which leads to impaired speech function. Because speech is one of the most important tools of social interaction, its disorder can significantly affect patients’ quality of life. To date, there is no generally accepted objective approach to assessing the quality of speech that would make it possible to analyze speech changes at different stages of therapy and help in development of treatment strategy.Aim. To compare the sound reproduction of patients with tongue cancer after hemiglossectomy with and without reconstruction using an objective assessment method, namely – a special software.Materials and methods. The study included 29 patients who received surgical treatment in the volume of hemiglossectomy with ipsilateral cervical lymphodissection. The patients were divided into 2 groups: the group 1 included 14 patients who underwent reconstruction with submental, radial and buccal flaps, the group 2 – 15 patients who did not underwent it. Sound reproduction by each patient was recorded before the operation, no earlier than 10–12 days after it (session of type 1) and after the end of specialized treatment: radiation therapy, chemoradiation therapy (session of type 2). If adjuvant therapy was not prescribed, the type 2 session was performed 3–6 months after surgery. The records made during sessions of the types 1 and 2 were compared with records of preoperative session. During each session, the pronunciation of 30 syllables containing 3 problematic sounds was recorded: [k], [s] and [t] (10 syllables with each of the sounds). The differences in the data obtained during the sessions types 1 and 2 were analyzed according both the syllable set and separately for each sound studied.Results. The reconstruction performed improves sound pronunciation [t] after hemiglossectomy both after surgery and 3–6 months after the end of specialized treatment (p

Tongue cancers are common in the spectrum of oral malignancies. In base of tongue cancers, tumour excision might lead to injury of ipsilateral or both lingual arteries, leading to ischemia of residual, native tongue. Free radial artery forearm flap is commonly used for tongue reconstruction. It can also be used as a flow-through flap for the reconstruction of the tongue defect as well as to revascularise the cancer-free tongue remnant. We report here two cases of base of tongue excision for which free flow-through radial forearm flap was used to reconstruct the tongue defect as well as salvage the remaining part of ischemic tongue. This technique can be effectively considered in selected cases of vascular compromise due to lingual vessel sacrifice to preserve the cancer-free anterior native tongue tissue with improved functional outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The tongue plays a crucial role in speech, swallow and sleep. It is the most common site of primary intraoral cancer. A fasciocutaneous free flap is the first reconstructive option after surgery. Materials and Methods: The aim of this study was to investigate the functional outcomes in patients treated with hemiglossectomy. We evaluated the objective tests and subjective assessments of swallowing, speech and sleep at 30 days after the surgery (T0) and at least 6 months after the end of the treatment (T1). We have implemented a battery of validated tools that comprehensively evaluate functional outcomes after resection of oral cancer, including speech, swallowing and head-and-neck-specific quality of life: MD Anderson Dysphagia Inventory (MDADI), Performance Status Scale-Head and Neck (PSS-HN) and Lazarus Tongue Range of Motion (ROM) Scale. Patients underwent objective tests such as videonasal endoscopic evaluation and magnetic resonance imaging. All patients were subjectively assessed with the Epworth Sleepiness Scale and underwent nocturnal polygraphy. Results: We treated six patients with advanced squamous cell carcinoma of the tongue; three received radial forearm flap and three received anterolateral thigh flap. Our study found that ROM, flap volume and defect volume are the most important characteristics for better MDADI, PSS-HN, Epworth score and respiratory disturbance index (RDI) on polygraphy. Discussion: Reconstruction of tongue cancer defects is challenging as the surgeon must consider adequate control of the tumour while also optimising residual functional capacity. The volume of the flap and ROM would seem to be the most important characteristics for improving the functional outcome. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Tongue reconstruction results following partial glossectomy using primary closure and local tissue rearrangement were evaluated in this study. METHODS: 7 patients diagnosed with tongue carcinoma were included. Tongue defects were reconstructed using local transposition, advancement and rotation of the remaining tongue tissue and closure of the defect. The patients were evaluated 6 months and 1 year following the surgery. RESULTS: None of the patients had permanent speech impairments or major swallowing problems following the surgery despite 33% to 50% reduction in tongue length. CONCLUSION: Unnecessary utilization of microvascular flaps for partial tongue reconstruction should be avoided in partial glossectomy patients in which reduction in tongue length is below 50%. [ABSTRACT FROM AUTHOR]

Soft tissue reconstruction of oral cavity defects, such as glossectomy defects secondary to malignancy, pose a challenge for head and neck, oral, and maxillofacial surgeons. Reconstruction options for mucosal defects include primary closure, healing by secondary intention, full mucosal and split-thickness skin grafts, pedicled flaps, and microvascular free flaps. Biological grafts have become an integral part of the modern reconstructive ladder and are widely used for the regeneration of various soft tissue defects, including oral defects. This case series describes our initial experience using ovine forestomach matrix grafts in tongue and oral cavity reconstruction. Oral reconstruction using ovine forestomach matrix grafts was undertaken on three patients post wide excision and resulted in good functional and cosmetic outcomes. The rate of tissue formation provided by the graft and the grafts’ relative resistance to the hostile environment of the oral cavity support further clinical research to validate the use of these devices in oral reconstruction.

Head and neck reconstruction, particularly tongue reconstruction, remains a formidable challenge. However, crafting a three-dimensional structure from a basic flap necessitates precise dimensions to avoid excess or insufficiency. At the same time, the tongue also has to be accommodated inside the oral cavity to prevent protrusion or repeated injuries due to tooth bites. This study aims to showcase the practicality of employing Pythagoras's formula in both preoperative and intraoperative settings to the required flap dimensions for partial and hemiglossectomy tongue defects. Between 2020 and 2022, we have undertaken 53 tongue reconstructions to address defects resulting from partial or hemiglossectomies. Among these cases, 51 were managed with free radial artery flaps, while in two we utilized anterolateral thigh flaps for reconstruction. Our study excluded cases involving minor tongue defects amenable to primary closure. By treating the length of the tongue defect as the hypotenuse, Pythagoras's formula is applied to calculate the optimal length and width of a free microvascular flap. The tongue reconstruction is performed, and microvascular anastomosis is carried out in the neck. An addition was made for associated buccal mucosa defects, if any. All flaps survived without any complications like bleeding, wound dehiscence, and partial or complete flap necrosis. Tongue movement was adequate, with good swallowing and good speech. The application of Pythagoras's formula provides a dependable method for determining flap size pre- and intraoperatively in cases of partial or hemiglossectomy tongue defects, leading to favorable functional and aesthetic results. [ABSTRACT FROM AUTHOR]

Purpose: Despite the significance and complexity of tongue reconstruction surgery, a digital tool for flap design is currently lacking. This study investigates the effectiveness of employing inverse finite element method (IFEM) for meticulously designing the geometric characteristics of harvested tissue (free flap) for tongue reconstruction. Methods: In the case of an artificially simulated hemiglossectomy, IFEM algorithm was applied for algorithmic flap design. The method's effectiveness was evaluated by assessing flap deformation in a simplified virtual reconstruction, focusing on parameters such as stress, strain, and thickness. Results: The IFEM algorithm successfully generated an optimal flap design for the intended surgical removal. Analysis of the flap's overall surface area, deformation characteristics, and safety margins demonstrated the feasibility of the deformation. Notably, the stress and thickness assessments suggested that the flap's tension post-surgery would not adversely affect the mobility of the reconstructed tongue, suggesting a positive outcome for functional recovery. Conclusion: The IFEM demonstrates significant potential as a tool for precise free flap design in tongue reconstruction surgeries. Its application could lead to improved surgical accuracy and better quality of life for patients undergoing such procedures. [ABSTRACT FROM AUTHOR]

Total glossectomy defects resulting from postoncologic resection are commonly reconstructed with locoregional or free flaps. However, effectively managing complications that may arise after reconstruction can be a significant challenge. We present a unique case series describing prosthetic management of flap-related complications following glossectomy in patients treated for locally advanced tongue cancer. Three patients underwent total glossectomy, neck dissection, reconstruction using free flap, and tracheostomy. Two patients developed an intraoral fistula located in the anterior region of the floor of the mouth. The third patient developed a flap failure requiring a second procedure using a pectoralis major myocutaneous flap for correction of the orocutaneous fistula that ultimately did not heal. Mandibular obturator prostheses lined with a soft liner were fabricated for all the patients, which helped reduce salivary incontinence and improve swallowing and speech. This case series highlights that a collaborative interdisciplinary team approach is crucial for optimizing postoperative function and outcomes when managing complications from reconstructive procedures.

Background/Aim: The tongue is an important anatomical structure, playing an significant role in natural speech, swallowing, and sense of taste. Immediate reconstruction using autologous tissue must be performed following glossectomy for tongue cancer to improve patient quality of life. This study aimed to demonstrate the usefulness of a surgical technique using the free vertical latissimus dorsi flap (FvLDF) for tongue reconstructions using autologous tissue. Patients and Methods: Among patients who underwent total glossectomy for tongue cancer from November 2014 to February 2023, we selected 10 patients who underwent immediate tongue reconstruction with a radial free forearm flap (RFFF) or free anterolateral thigh flap and four patients who underwent FvLDF. The patients were compared regarding postoperative function (width of oropharyngeal space in computed tomography, language-speech evaluation), aesthetic results, and features. Results: All four patients who underwent FvLDF showed successful flap survival, with no severe complications. Because vertical incision was made during flap harvest with primary closure possible with the mid-axillary line, donor morbidity was significantly lower in patients who underwent reconstruction with FvLDF than in those who underwent reconstruction with RFFF, and good aesthetic results were obtained. In comparing the oropharyngeal space of patients on neck CT preoperatively and postoperatively, the width increase rate of patients who underwent reconstruction with FvLDF was significantly smaller. FvLDF patients demonstrated good speech and swallowing functions. Conclusion: Considering the advantages of reconstruction with FvLDF in terms of features and aesthetic results, this surgical technique may be a reliable alternative technique for tongue defects after glossectomy. [ABSTRACT FROM AUTHOR]

Background: Oral squamous cell carcinoma (oSCC) commonly affects the tongue. Surgical reconstruction contributes to improvements in quality of life. Therefore, we conducted this systematic review to compare the quality of life among patients who underwent glossectomy and then reconstructed with radial-free forearm flap (RFFF) versus anterolateral thigh flap (ALTF) in terms of functional outcome, flap survival, complications, donor site morbidity, and esthetic outcome. Methods: This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The study systematically reviewed MEDLINE, Cochrane, and EMBASE databases without specifying a time frame. Results: As a result of reviewing literature, 95 articles were screened by full-text resulting in 36 articles which met our inclusion/exclusion criteria. However, only 14 articles were included in the quantitative synthesis (meta-analysis). Out of the 36 articles, 24 studies were excluded from the meta-analysis due to the inclusion of one arm (RFFF or ALTF), and 3 articles were excluded due to the lack of the primary outcomes. Conclusions: Our results show evidence of lower donor site morbidity and a better esthetic outcome for ALTF compared to RFFF. Speech and swallowing were both affected following tongue reconstruction. Level of evidence: Not gradable. [ABSTRACT FROM AUTHOR]

Total glossectomy defects resulting from postoncologic resection are commonly reconstructed with locoregional or free flaps. However, effectively managing complications that may arise after reconstruction can be a significant challenge. We present a unique case series describing prosthetic management of flap-related complications following glossectomy in patients treated for locally advanced tongue cancer. Three patients underwent total glossectomy, neck dissection, reconstruction using free flap, and tracheostomy. Two patients developed an intraoral fistula located in the anterior region of the floor of the mouth. The third patient developed a flap failure requiring a second procedure using a pectoralis major myocutaneous flap for correction of the orocutaneous fistula that ultimately did not heal. Mandibular obturator prostheses lined with a soft liner were fabricated for all the patients, which helped reduce salivary incontinence and improve swallowing and speech. This case series highlights that a collaborative interdisciplinary team approach is crucial for optimizing postoperative function and outcomes when managing complications from reconstructive procedures. [ABSTRACT FROM AUTHOR]

Background: Oral cancer is one of the most common cancers not only in India but also in South Asia. Treatment of oral cancer is not only limited to cure but also requires good reconstruction of the surgical defects for a better quality of life. There are many well-proven options for reconstruction purposes for the defects of the oral cavity, including local regional flaps to microvascular‑free flaps. After resections of mobile parts of the tongue (up to 50%), speech and swallowing are impaired significantly; however, even after sophisticated plastic reconstruction, serious swallowing and speech problems persist. Methods: The clinical study was carried out to on 30 patients having carcinoma of the tongue. They were allocated into two treatment test group, one was the radial forearm flap and the other was infrahyoid myocutaneousflap (IHF) group to evaluate and compare the treatment outcome for reconstruction using two different treatment modalities. The prospective clinical trial was carried out after the allocation of patients with carcinoma of the tongue into two treatment test groups. The clinical parameters, likewise swallowing reflex, speech analysis, and tongue movements, were evaluated using IBM SPSS Statistics for Windows software, 20.0 (IBM Corp., Armonk, USA). Both descriptive statistics and the inferential statistics involving one-way ANOVA and Tukey’s Post hoc test were analyzed to compare both intergroup and intragroup comparison at different time intervals. Results: The swallowing and aspiration analysis showed a highly statistically significant difference at 3 months and 6 months by Post hoc test between the groups. The results for tongue movements were statistically significant, henceforth better for the IHF group. Conclusion: The infrahyoid flap is a quick, easy, and reliable reconstructive method, which is cost‑effective when used with knowledge of its clinical utility and limitations, the functional results are excellent with great patient satisfaction. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the effectiveness of buccinator myomucosal island flaps for tongue reconstruction following malignant tumor resections. A retrospective study was performed on 52 patients who underwent tongue reconstructions with buccinator myomucosal island flaps between 2012 and 2020. We reviewed the flap type and size, harvesting time, recipient- and donor-site complications, postoperative oncologic outcomes, functional recovery and QoL assessment. All of the flaps were transposed successfully without any total flap loss. Neither in the primary site nor in the neck were cancer relapses observed. An evaluation of the sensitivity revealed that 96.1% of patients experienced a recovery of touch, two-point and pain sensations. There were significant differences between the flap and the native mucosa in terms of the tactile (p < 0.001), pain (p < 0.001) and two-point (p < 0.001) thresholds. The average swallowing score recorded was 6.1 out of 7, with only minor complaints. The quality of life assessments demonstrated high scores across physical (24.5 out of 28), social (25.8 out of 28), emotional (20.3 out of 24) and functional (25 out of 28) aspects. The present study showed how buccinator myomucosal island flaps represent an effective and functional tongue reconstructive option, requiring a short operative time with a low rate of donor site morbidity, and with evidence of long-term oncologic safety and high quality of life. [ABSTRACT FROM AUTHOR]

Background: Anterolateral thigh (ALT) and Radial forearm free flaps (RFFF) are historically the most common methods of oral reconstruction. The Superficial circumflex iliac artery perforator flap (SCIP) is an alternative providing a donor site that can be readily closed primarily with improved cosmesis in younger patients, due to its concealability. Methods: We reviewed 135 patients who received ALT, RFFF or SCIP flaps for oral reconstruction in our institution. Our aim was to compare operative and perioperative outcomes between each cohort. ANOVA and χ2 test were used for statistical analysis. Results: There were 37 ALT, 64 RFFF and 35 SCIP reconstructions. Patients reconstructed with SCIP flaps had smaller resection volumes (P < 0.001) and earlier T and N classifications (P = 0.001, P = 0.008), and consequently reduced tracheostomy rates (P < 0.001), reduced need for enteral feeding at discharge (P < 0.001) and shorter length of stay and perioperative times (P < 0.001). SCIP flaps were more common in younger patients (P < 0.01). ALT flaps were used for more advanced disease (P = 0.001) and had larger resection volumes (P < 0.001) and increased need for assisted enteral feeding (P < 0.001). There were no significant differences in flap or donor site outcomes. There were two flap failures, both RFFF. Conclusion: Each flap plays an important role in the reconstruction of oral defects, with larger defects preferentially reconstructed with ALT flaps. SCIP appears to be a reliable alternative in small defects with excellent perioperative and postoperative outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Oral cancer is one of the most common cancers not only in India but also in South Asia. Treatment of oral cancer is not only limited to cure but also requires good reconstruction of the surgical defects for a better quality of the life. There are many well-proven options for reconstruction purposes for the defects of the oral cavity including local regional flaps to microvascular-free flaps. After resections of mobile parts of the tongue (up to 50%) speech and swallowing are impaired significantly, however, even after sophisticated plastic reconstruction, serious swallowing and speech problems persist. Material and Methods: The pilot study was carried out after the allocation of fourteen patients with carcinoma of the tongue into two treatment test groups; the Radial forearm flap (RFF) and Infrahyoid neuromuscular flap (IHF) group to evaluate and compare the treatment outcome for reconstruction using two different treatment modalities. The pilot study was carried out after the allocation of fourteen patients with carcinoma of the tongue into two treatment test groups. the clinical parameters likewise swallowing reflex, speech analysis, donor site complication, time taken for the surgery, and cost-effectiveness of the flap was evaluated using IBM SPSS Statistics for Windows software, 20.0 (IBM Corp., Armonk, USA). The data were numerically coded and entered into the program. Both the descriptive statistics and the inferential statistics involving one-way ANOVA and Tukey's Post Hoc test were analyzed to compare both intergroup and intragroup comparisons at different time intervals. Results: The swallowing and aspiration analysis showed a highly statistically significant difference at 3 months and 6 months by Post Hoc test between the groups. The speech analysis scores at all intervals were not statistically significant while for tongue movements the results were significant. The time taken and expenditure for surgery by IHF were less in comparison to RFF. Conclusion: The infrahyoid flap is a quick, easy, and reliable reconstructive method, which is cost-effective when used with knowledge of its clinical utility and limitations, the functional results are excellent with great patient satisfaction. [ABSTRACT FROM AUTHOR]

Hong Loi Nguyen,1 Nhat Huy Tran,2 Van Khanh Nguyen1 1Odonto-Stomatology Center, Hue Central Hospital, Hue City, 530000, Vietnam; 2Oncology Center, Hue Central Hospital, Hue City, 530000, VietnamCorrespondence: Hong Loi Nguyen, Odonto-stomatology Center, Hue Central Hospital, 16 Le Loi Street, Hue City, 530000, Vietnam, Tel +84913498549, Email drloivietnam@yahoo.com.vnAbstract: 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.Keywords: tongue reconstruction, hemiglossectomy, submental flap

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. [ABSTRACT FROM AUTHOR]

The infrahyoid flap (IHF) is a myocutaneous pedicled flap, which is mostly supplied by the superior thyroid vessels through the infrahyoid muscle perforators. The flap is thin as well as pliable which provides a skin island that is approximately 7 by 4 cm from the central part of the anterior neck. The flap can be transferred on its pedicle of the superior thyroid artery and vein to reconstruct medium-sized head and neck defects created after cancer excision. One of the best substitutes considered for the reconstruction of moderate defects is the infrahyoid myocutaneous flap. It can be carried out for the defects in the oral cavity, oropharynx, or hypopharynx carcinomas. The flap can be either unilateral or bilateral superior thyroid pedicle flaps but the main limitations are restricted arc of rotation and small flap volume. The IHF is contraindicated in cases with prior irradiation as well as cases of neck metastasis. The flap is reliable, easy to harvest during neck dissection, oncologically it is safe, and it carries a negligible donor site morbidity. The data from various databases PubMed/Medline, Scopus, Web of Science, and Google Scholar were included. The inclusion criteria were that only the review papers were included and that too published in the English language. This review paper highlights how the IHF can represent an excellent reconstructive solution to head and neck surgery as a tongue flap. [ABSTRACT FROM AUTHOR]

Abstract Objective Tongue defect reconstruction is one of the key components of tongue cancer surgery. In this study, we used an L-shaped flap design adopted as a simple and efficient method to repair tongue defects after hemiglossectomy. Furthermore, we evaluated and contrasted the clinical effects of two methods, the L-shaped and traditional methods. Study design Fifteen patients in the L-shaped group and 20 patients in the traditional group were evaluated and compared in terms of postoperative complications, dysphagia, language function and appearance satisfaction. Results The results (Table 1) showed that there were 2 cases of donor area invalid traumas, and 2 patients had scar hyperplasia in the traditional group. The degree of global and functional dysphagia of the L-shaped group (2.60 ± 0.29 and 11.47 ± 1.38) was lower than that of the traditional group (3.55 ± 0.29 and 15.75 ± 1.22) (P

The infrahyoid flap (IHF) is a myocutaneous pedicled flap which is mostly supplied by the superior thyroid vessels through the infrahyoid muscles perforators. The flap is thin and it could be transferred as a pedicle of superior thyroid artery along with the vein for the reconstruction of medium-sized defects of head and neck surgeries. The added advantage of this flap is that it is pliable and provides a skin island which is approximately seven by four centimeters from the central part of the anterior neck. The best substitute for reconstruction of oral defects is IHF. It can be carried out for the moderate defects of mouth along with that of pharynx carcinomas. The flap can be either unilateral or bilateral superior thyroid pedicle flaps but the main limitations are restricted arc of rotation and small flap volume. The IHF is contraindicated in cases with prior irradiation as well as cases of neck metastasis. The flap is most trusted and can be easily yielded during dissections of the head and neck; oncologically, it is safe and it carries least morbidity of the donor site.

Tongue repair after radical surgical removal of malignant tumors with subsequent rehabilitation of patients and their return to normal life and work has been a challenging issue for decades.This review aims to give an up to date summary of existing literature on different methods of tongue repair in cancer patients depending on the type of defect. We describe advantages and disadvantages of local and regional free autologous grafts.

Abstract Objective To evaluate the feasibility and outcomes of porcine submucosal allograft (Biodesign Sinonasal Repair Graft [Cook Medical, Bloomington, IN]) in oral cavity and oropharynx reconstruction after ablative surgery. Methods We conducted a prospective and retrospective review of patients who underwent Biodesign Sinonasal Repair Graft reconstruction for oral and oropharyngeal surgical defects at a single institution between 2018 and 2020. A total of 11 patients were included in the study. Data points included their perioperative medical and demographic data, immediate postoperative course, and follow‐up visits at 10 days and at 2 months. The clinicopathologic characteristics of their disease, postoperative esthetic, and functional outcomes were recorded and analyzed. Results Eleven procedures have been performed, and all patients received Biodesign reconstruction either immediately after ablation or after they failed a previous reconstruction. None of the patients had bone exposure. The subsites included oral tongue (n = 6), floor of the mouth (n = 3), buccal mucosa (n = 1), and soft palate (n = 1). In all cases, the operations and the postoperative course were uneventful. The mean defect size was 22 cm2. The median start of oral intake was at 2 days postoperatively. The Biodesign graft healed well in all patients with no total graft loss. There was one complication that required revision surgery due to obstruction of Wharton's duct by the Biodesign material. Conclusions Biodesign can be a viable option for small and medium‐sized oral and oropharyngeal defects in patients who are medically unfit or do not want to undergo a free flap surgery. Level of Evidence 4.

Tongue reconstruction can be simple to complex depending on the size of the defect. Reconstruction of medium-to-large size defect is technically demanding to achieve better esthetic and functional outcome. There are various options in the reconstruction of tongue defect when it comes to the type of flap. Any type of flap has its own advantages and disadvantages. Local flaps seem to be the best option, as it avoids secondary donor site morbidity and has similar tissue characteristics as native tissue, therefore provides better esthetic and functional results. This case report illustrates a case of tongue reconstruction that was performed with the help of tongue base island flap after wide local excision of verrucous carcinoma, which provided us with excellent results. [ABSTRACT FROM AUTHOR]

Background: Salvage surgery with reconstruction of the second and next primary tongue cancer remains difficult, especially after earlier neck dissection and radiotherapy. In the current report, we describe the feasibility of the extended, double-pedicled facial artery musculomucosal (dpFAMM) flap in the reconstruction of the patient with second primary tongue squamous cell carcinoma, after facial vessel ligation and radiotherapy. Case presentation: An 81-year-old female patient was operated on due to tongue squamous cell carcinoma (SCC) on the left side T3N1M0 in 2019. Bilateral selective neck dissection with tongue reconstruction was performed by island FAMM flap. The patient also suffered from synchronous mucinous breast carcinoma treated with tamoxifen. The second primary SCC of the tongue on the opposite (right) side was detected in 2020. The patient did not agree to surgical treatment; therefore, radiotherapy was performed. The local recurrence of the tongue cancer of the right side was treated surgically in 2021. Salvage surgery comprised hemiglossectomy and dpFAMM flap reconstruction with uneventful postoperative follow-up. Conclusions: This case presentation proved that dpFAMM flap can be used in salvage surgery and reconstruction even in patients after ligation of facial vessels, irradiation, and in the course of hormone therapy. The flap is easy to handle, has good vascularity, and comprises a predictable method of reconstruction, especially for patients with severe comorbidities. [ABSTRACT FROM AUTHOR]

Objective: To study the speech outcomes in patients undergoing tongue reconstruction after tumour resection in terms of intelligibility and to examine the factors influencing the outcome. Study Design: Prospective observational study. Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad, Jan 2015 to Jan 2020. Methodology: A total of 109 patients diagnosed with tongue cancer meeting the inclusion criteria were included in the study. All the participants underwent tumor resection followed by adjuvant radiotherapy (unless refused by the patients). Patients were followed for six months and then underwent speech evaluation via the Functional Intra-oral Glasgow Scale score and Likert scale. Results: Thirty (27.5%) patients could be clearly understood at all the times, while 27 (24.8%) and 42 (38.5%) required some and frequent repetition, respectively. Nine (8.3%) patients could only be understood by close relations and one patient was completely unintelligible. Advancing age (p=0.01), male gender (p=0.01), tumour stage (p=0.004), presence of comorbidities (p=0.004) and degree of resection (p=0.004) had a significant statistical relationship with speech outcome. Addiction (p=0.32), adjuvant radiotherapy (p=0.97) and the development of complications (p=0.59) had no effect on speech. Conclusion: The provision of a mobile reconstructed tongue gives speech intelligibility in a majority of the patients however, the degree of speech recovery is directly dependent on advanced age, disease stage, the presence of comorbidities and degree of resection. [ABSTRACT FROM AUTHOR]

Objective: Tongue defect reconstruction is one of the key components of tongue cancer surgery. In this study, we used an L-shaped flap design adopted as a simple and efficient method to repair tongue defects after hemiglossectomy. Furthermore, we evaluated and contrasted the clinical effects of two methods, the L-shaped and traditional methods.Study Design: Fifteen patients in the L-shaped group and 20 patients in the traditional group were evaluated and compared in terms of postoperative complications, dysphagia, language function and appearance satisfaction.Results: The results (Table 1) showed that there were 2 cases of donor area invalid traumas, and 2 patients had scar hyperplasia in the traditional group. The degree of global and functional dysphagia of the L-shaped group (2.60 ± 0.29 and 11.47 ± 1.38) was lower than that of the traditional group (3.55 ± 0.29 and 15.75 ± 1.22) (P < 0.05). In the language evaluation, the traditional group (3.20 ± 0.26) had lower scores than the L-shaped group (4.13 ± 0.30) (P < 0.05).Conclusion: The L-shaped ALTP flap is a simple and efficient modification of ALTP, that can be used for half-tongue repair after radical operations for tongue cancer. It has better performance in the recovery of dysphagia and language function than the traditional ALTP flap. [ABSTRACT FROM AUTHOR]

Objective: Therapeutic evaluation of applying superficial circumflex iliac artery perforator (SCIP) flap in tongue reconstruction after hemiglossectomy.Methods: We retrospectively collected a total number of 14 patients who received SCIP flap reconstruction for tongue defects at the Fujian Medical University affiliated Union Hospital, between November 2016 and November 2020. We evaluated the clinical features of the flap, analyzed the postoperative functions and esthetic effects after 6 months of the tongue reconstruction.Results: All the SCIP flaps survived successfully after the operation, the recipient site tongue bodies were well reconstructed 6 months after the surgery. Patient speech and swallowing functions were well recovered during the follow-up. The scars in the donor site were concealed with limited numbness.Conclusions: With the advantages of the hidden donor site and aesthetic benefits, the SCIP flap is a reliable option for the reconstruction of the tongue defect after hemiglossectomy.

The medial sural artery perforator free flap (MSAP) has gained increasing popularity in head and neck reconstruction. Its slightly bulkier nature than the radial forearm flap, combined with negligible donor site morbidity, makes it an ideal candidate for the reconstruction of partial glossectomy defects. The ability to harvest the MSAP as a chimeric flap with a portion of the medial gastrocnemius muscle gives it greater flexibility in soft tissue reconstruction. A retrospective study of patients with partial glossectomy defects reconstructed using the MSAP by a single surgeon was performed. Perioperative data, donor and recipient site characteristics, complications, and outcomes were analyzed. A video is included to show technical points for the harvest of the flap. A total of 10 patients were included. The average age was 59.1 years, with a mean of 43.5% of the tongue resected. All flaps survived, with no major complications. At follow-up, the patients had regained an average of 86.5% of original speech, with none requiring NG feeding. The average MSAP skin flap thickness was 7.8 mm, with 6 flaps being harvested as chimeric fasciocutaneous muscle flaps. Five flaps incorporated 2 perforators. Two case examples are presented. The chimeric MSAP perforator allows for more robust partial glossectomy reconstruction with improved postoperative functional outcomes. It should be considered as the workhorse flap for partial tongue reconstruction. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility and outcomes of porcine submucosal allograft (Biodesign Sinonasal Repair Graft [Cook Medical, Bloomington, IN]) in oral cavity and oropharynx reconstruction after ablative surgery. Methods: We conducted a prospective and retrospective review of patients who underwent Biodesign Sinonasal Repair Graft reconstruction for oral and oropharyngeal surgical defects at a single institution between 2018 and 2020. A total of 11 patients were included in the study. Data points included their perioperative medical and demographic data, immediate postoperative course, and follow‐up visits at 10 days and at 2 months. The clinicopathologic characteristics of their disease, postoperative esthetic, and functional outcomes were recorded and analyzed. Results: Eleven procedures have been performed, and all patients received Biodesign reconstruction either immediately after ablation or after they failed a previous reconstruction. None of the patients had bone exposure. The subsites included oral tongue (n = 6), floor of the mouth (n = 3), buccal mucosa (n = 1), and soft palate (n = 1). In all cases, the operations and the postoperative course were uneventful. The mean defect size was 22 cm2. The median start of oral intake was at 2 days postoperatively. The Biodesign graft healed well in all patients with no total graft loss. There was one complication that required revision surgery due to obstruction of Wharton's duct by the Biodesign material. Conclusions: Biodesign can be a viable option for small and medium‐sized oral and oropharyngeal defects in patients who are medically unfit or do not want to undergo a free flap surgery. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Background and Objectives: The reconstruction of tongue defects after cancer resection is challenging for reconstructive surgeons. The facial artery musculomucosal (FAMM) flap and the myomucosal buccinator flap (Bozola flap) are important tools in the reconstruction of intraoral defects. In this study, we describe the combination of both flaps--the extended, double-pedicled FAMM (dpFAMM) flap--and present clinical results of the reconstruction of moderate tongue defects in edentulous patients. Materials and Methods: a tongue defect, after squamous cell carcinoma excision, was reconstructed with the dpFAMMflap in 5 patients. Most of them received postoperative radiotherapy. Results: the healing process was uneventful in all patients. We did not observe flap necrosis or venous congestion. Tongue mobility, speech and swallowing were satisfactory. Conclusions: In conclusion, the dpFAMM flap is a good alternative in the reconstruction of moderate defects of the lateral part of the tongue. The flap is easy to harvest and has a good vascularity. This is a predictable method of reconstruction, especially for elderly patients with numerous comorbidities. [ABSTRACT FROM AUTHOR]

Background  For tongue reconstruction, the radial forearm flap (RFF) is commonly used. In the last decade, the medial sural artery perforator (MSAP) flap has been successfully used with reportedly superior donor-site outcomes. Our study is the first to compare the RFF and MSAP for reconstruction of partial glossectomy defects (<50% of tongue). Methods  We conducted a retrospective review of 20 patients with partial glossectomy defects reconstructed at a tertiary referral center. Patient demographics, perioperative data, and postoperative complications were analyzed. Objective measures of speech, swallowing, and subjective patient satisfaction with their donor site were recorded. Results  Ten RFF and MSAP were each used, with a mean partial glossectomy defect size of 40.5 and 43.5%, respectively. The MSAP was significantly thicker (7.8 vs. 4.3 mm, p  < 0.05) with a longer harvest time (122.5 vs. 75.0 minutes, p  < 0.05). There were no cases of free flap failure. Donor-site healing times were comparable, but the MSAP group experienced significantly less donor-site complications (n  = 1 vs. n  = 7, p  < 0.05). Functional outcomes were comparable with 13 patients achieving normal speech and diet after 3 months (MSAP = 6 vs. RFF = 7, p  = 1.00). All patients were satisfied with their donor-site outcome with the MSAP group having a marginally higher score. Conclusion  Both flaps are good options for partial glossectomy reconstruction. Though more challenging to harvest, the MSAP gives comparable functional results and has become our first reconstructive option given its superior donor-site outcomes. [ABSTRACT FROM AUTHOR]

Background: Nasolabial flap is reliable flap in the reconstruction of oral defects over a period of time. Still there is scanty literature available of using this flap for reconstruction of isolated defects of tongue. We carried out this study in our patients to assess the role of pedicled nasolabial flap in reconstruction of isolated tongue defects. Methods: In total, 11 patients with T1 and T2 tongue cancer were selected for the study. The functional improvement in the form of speech and swallowing was evaluated postoperatively. Results: The flap was successfully taken in all patients except for marginal or tip loss. This is a locally available flap with minimal operating time and does not require microvascular skills. The results of speech and swallowing after reconstruction were comparable. Conclusion: Nasolabial flap is an excellent locally available flap for the reconstruction of the anterior two-thirds of the tongue and with very minor, if any postoperative cosmetic defect. [ABSTRACT FROM AUTHOR]

Background: Squamous cell carcinoma (SCC) of the oral tongue is an aggressive disease and mandates upfront surgery, appropriate reconstruction, and adjuvant therapy as indicated. Contemporary tongue reconstruction has been largely aided by free flaps, making it possible to tailor the flap precisely to the defect. Aims and Objectives: We aimed to assess functional outcomes of our post glossectomy patients subsequent to reconstruction and aimed to identify the flap types associated with the highest satisfaction rates. Methodology: We retrospectively evaluated a cohort of 145 patients with SCC of the oral tongue, who underwent glossectomy at our institution between March 2011 and July 2017. These patients had been reconstructed as per our volume-aided institutional algorithm with primary closure, radial forearm-free flap (RFFF), pectoralis major myocutaneous flap (PMMF), or anterolateral thigh-free flap. Appropriate analysis on surviving and functionally evaluable patients was done through a trilingual confidential IRB-validated phone administered questionnaire. Results: The subjective outcomes were most satisfactory for patients reconstructed with RFFF, which per our institutional algorithm forms the flap of choice for oral tongue volume restoration to the extent of 30%–50%; and also for primary closure, our preferred method for 0%–30% volume restoration. Subjective satisfaction with respect to speech and swallowing was the lowest when the PMMF was utilized for reconstruction. Notably, PMMF was only utilized for tongue reconstruction in severely comorbid patients. Conclusions: Oral tongue reconstruction should aim at restoration of mobility, structural support, restoration of bulk, and obviation of tracheotomy, among other aims. Primary closure for smaller defects and a skin-lined free flap for larger defects appear to be associated with high rates of subjective satisfaction across all parameters.

A new modification by hyoid suspension improves swallowing function and risk of aspiration in postglossectomy tongue reconstruction patients.

Introduction The tongue is the most important organ involved in voice, bolus formation, and swallowing. As the tongue is a highly specialized tissue, restoring of the tongue is one of the major challenges facing oncological reconstructive surgeons. Patient and methods Since 2013, we have reconstructed 60 resections of the tongue using a free flap [radial forearm, anterolateral thigh (ALT)]. The complete mobile tongue resection (total and near-total tongue resection) represented a small group of 10 patients. We checked the records of the seven patients who had been reconstructed with an ALT flap with a cathedral design. The seven patients (five males and two females) underwent a complete mobile tongue reconstruction with an ALT free flap with a cathedral design. Result All flaps survived with no need for flap revision. All flaps had a natural shape and volume of the tongue, even after radiotherapy, allowing adequate dental and palatal contact. Conclusion This kind of shaping of the ALT flap has a good and direct effect on the quality of life o patients as regards swallowing, speech, and deglutition of our patients. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the efficacy and long‐term outcome of a modification of the anterior‐posterior tongue rotation flap used for reconstruction of tongue following cancer ablation. From April 2016 to September 2017, 21 consecutive patients with tumor classification (T2), lymph node classification (N0) tongue cancer on the anterior and middle one‐third portion were selected for this study. A modification of the anterior‐posterior tongue rotation flap was selected for tongue reconstruction after the cancer resection. Patient's scorings of swallowing, chewing, speech and taste were recorded. Patient after tongue flap reconstruction acquired satisfied tongue movement that allows normal functional outcomes for swallowing, chewing, speech and taste. Local tumor recurrence was not observed during the follow‐up examination (range, 12‐24 months). The modification of the anterior‐posterior tongue rotation flap was a safe and reliable treatment for medium‐size tongue cancer (T2N0), especially suitable to patients who cannot endure prolonged surgery. [ABSTRACT FROM AUTHOR]

The superficial inferior epigastric artery (SIEA) flap is widely used in the repair of large soft tissue defects of the extremities and in breast reconstruction. Because of the high fat content of the abdomen, it has been less used for glossectomy reconstruction. Here we present a series of seven patients who each underwent reconstruction with a thin SIEA flap after resection of the tongue. There were six men and one woman (mean age 48, range 24–66 years). All patients underwent preoperative computed tomographic (CT) angiography, and colour Doppler ultrasound (US) was used to select and map the most suitable SIEA. The flap was raised above the Scarpa's layer while adjusted the plane of dissection according to the specific needs for bulk in each case. All the flaps survived; one flap required a secondary anastomosis because of a venous anastomotic embolus. The size of flap used was 5.0 cm × 6.0 cm - 7.0 cm × 9.0 cm, and the flap was 0.8 cm-1.4 cm thick. The functional outcome was evaluated at 6 - 18 months follow up, when speech and swallowing were both good in all cases. The dissection above the pubic symphysis is an important refinement of the SIEA flap, and we conclude that the thin SIEA flap is a good choice for reconstruction after excision of cancer of the tongue. [ABSTRACT FROM AUTHOR]

Background: Submental artery island flap (SIF) is a viable alternative to free flaps for selected oral‐cavity defects, however, concerns about its oncologic safety still exists. A novel harvesting technique and its outcome is described in here. Methods: This is a prospective study for patients with lateralized oral tongue and/or floor of mouth (FOM) cancers who undergone reconstruction using pedicled SIF based on contralateral submental vessels (CSIF) following resection. Results: Forty‐one patients were included. Twenty‐four patients had T2, 13 had T3, and 4 had T1 tumors. The largest flap skin paddle was 15 × 9 cm. One patient sustained complete and five sustained partial flap loss. Three patients developed tongue tethering. Median follow‐up was 13.6 months. Locoregional recurrence occurred in 11 patients (26.8%); 6 oral‐cavity recurrences (14.6%), 6 ipsilateral, and 1 contralateral neck recurrences (2.4%). Conclusion: CSIF is a reliable flap that addresses the oncologic controversy and overcomes the disadvantages of ipsilateral flap. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine whether the islanded facial artery myomucosal flap (iFAMM) is a good alternative to fasciocutaneous free flaps (FCFF) in the reconstruction of lateral oral tongue defects. This was a retrospective study of 40 patients with oral tongue cancers (lateral lesions not >4 cm) operated on between August 2014 and March 2017, who underwent primary reconstruction with either an iFAMM or FCFF. The two groups were compared with respect to intraoperative time, total intensive care unit (ICU) and hospital stay, complications, speech, swallowing, aesthetics, donor site morbidity, and economic feasibility. Patients who had an iFAMM had a reduced operating time, duration of ICU stay, and length of hospitalization; this flap was also more economically feasible. Better aesthetics and less donor site morbidity were also seen. The iFAMM is an alternative to FCFF in the reconstruction of lateral oral tongue defects, as it is less technically demanding, has good aesthetic outcomes, and is more economical, with acceptable donor site morbidity. [ABSTRACT FROM AUTHOR]