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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.

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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%.

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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.

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This report presents the use of an innervated musculocutaneous submental artery island flap (MSAIF) for the functional reconstruction of a hemiglossectomy defect, with the aim of preserving the volume and mobility of the reconstructed tongue to facilitate swallowing and intelligible speech. A 30-year-old male patient diagnosed with T3N0 stage squamous-cell carcinoma of the tongue underwent hemiglossectomy and ipsilateral I-IV selective neck dissection. For reconstruction, an innervated MSAIF with a 9x4 cm skin paddle, including the left submental vessels, ipsilateral anterior belly of the digastric muscle, mylohyoid muscle, and mylohyoid nerve, was harvested and inserted into the tongue defect. Postoperative healing at both donor and recipient sites proceeded without complications. At a three-year follow-up, the MSAIF has maintained its volume, mobility, and contractility. The patient remains disease-free and reports satisfaction with his swallowing and speech capabilities. The innervated MSAIF represents a reliable and cost-effective reconstruction approach for hemiglossectomy defects, showing favorable results in both swallowing and speech.

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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.

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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.

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This systematic review aims to provide insight into the ideal reconstructive approach of the oral tongue in oral tongue cancer (OTC) by investigating the relationship between functional outcomes and the extent of tongue resection. A structured search was performed in Ovid MEDLINE, EMBASE, and Web of Science. Studies comparing patient-reported and objective measurements of the oral tongue function between flap vs. non-flap reconstruction were included. Functional outcomes of interest were speech production, deglutition efficiency, tongue mobility, overall quality of life, and postoperative complications. A total of nine studies were retrieved and critically appraised. Patients with 20 % or less of oral tongue resected had superior swallowing efficiency and speech intelligibility with a non-flap reconstruction while patients with a tongue defect of 40-50 % self-reported or demonstrated better swallowing function with a flap repair. The data in intermediate tongue defects (20-40 % tongue resected) was inconclusive, with several studies reporting comparable functional outcomes between approaches. A longitudinal multi-institutional prospective study that rigidly controls the extent of tongue resected and subsites involved is needed to determine the percentage of tongue resected at which a flap reconstruction yields a superior functional result in OTC.

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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.

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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.

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BACKGROUND: To achieve improved functional outcomes in subtotal tongue reconstruction, a flap design with sufficient volume and appropriate shape is necessary. In this study, we introduce an "Individualized and Convenient Tongue Model" (ICTM) for flap design in subtotal tongue reconstruction. METHODS: By studying the anatomical morphology of the tongue, we found a similar geometry within the dorsum and body of the tongue as well as the mouth floor. This can be used to create an ICTM through folding and splicing. We can simulate tongue defects in the ICTM and transform defect shapes into guide plates for flap design. In this study, fifty-eight patients requiring subtotal tongue reconstruction were randomly divided into two groups: an ICTM group (35 patients) and a conventional group (31 patients). In the ICTM group, we individually designed profunda artery perforator flaps (PAPFs) or anterolateral thigh flaps (ALTFs) using the ICTM method. In the conventional group, the flap was designed according to the surgeon's clinical experience. Patient demographics, operative and follow-up data were recorded. Swallowing, speech intelligibility, and cosmetic results were assessed using appropriate scales. RESULTS: All flaps survived, although there were no significant differences in tumor size, operation time, flap size, and complication rate compared to the conventional group. Patients in the ICTM group had significantly improved speech intelligibility (p = 0.019), cosmetic appearance (p = 0.009), and swallowing ability (p = 0.003). CONCLUSIONS: The ICTM technique is an effective and convenient solution for subtotal tongue reconstruction that provides an individualized flap design and improves functional outcomes compared to the conventional design.

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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.

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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.

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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.

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INTRODUCTION: Surgical treatment for oral cancer leads to lasting changes of the vocal tract and individuals treated for oral cancer (ITOC) often experience speech problems. The purpose of this study was to analyse the acoustic properties of the spontaneous speech of individuals who were surgically treated for oral cancer. It was investigated (1) how key spectral measures of articulation change post-treatment; (2) whether changes are more related to target manner or place of articulation; and (3) how spectral measures develop at various time points following treatment. METHOD: A corpus consisting of 32.850 tokens was constructed by manually segmenting the speech of five (four female - one male) American English speaking ITOC. General acoustic characteristics (duration and spectral tilt), plosives (burst frequency), fricatives (centre of gravity and spectral skewness), and vowels (F1 and F2) were analysed using linear mixed effects regression and compared to control speech. Moreover, a within speaker analysis was performed for speakers with multiple recordings. RESULTS: Manner of articulation is more predictive of post-treatment changes than place of articulation. Compared to controls, ITOC produced the fricatives /f, v, θ, ð, s, z, ʃ, ʒ/ with a lower centre of gravity while no differences were found for plosives and vowels. Longitudinal analyses show high within-speaker variation, but general improvements one-year post-treatment. CONCLUSIONS: Surgical oral cancer treatment changes the spectral properties of speech. Fricatives with varying manner of articulations were distorted, suggesting that manner of articulation is more predictive than place of articulation in identifying general problem areas for ITOC.

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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.

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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.

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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.

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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.

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