Controversies in Tongue Reconstruction

초록

Functional reconstruction after tumour resection of tongue squamous cell carcinoma remains a clinical challenge. There were several issues of the treatment option for tongue squamous cell carcinoma. With the development of microsurgical techniques, microvascular free flaps are considered ideal options for the reconstruction of defects in the head and neck region after tumour resection. For years, the first choice for restoring soft tissue ablation in the oral cavity was the radial forearm flap (RFF). However, the sacrifice of such an important artery in the hand and the necessity of skin grafting have limited its use. Current reconstructive options either maintain mobility or provide bulk. According to the defect size, The surgeon would choice the flap for bulkiness, site and mobility of the tongue reconstruction. In hemiglossectomy, a radial forearm flap is recommended because of its thinness, pliability, and long pedicle, sometimes, the ALT perforator flap can be used instead in thin patients. In subtotal or total glossectomy, the ALT musculocutaneous flap rather than the fasciocutaneous flaps should be used for reconstruction to provide more bulk to augment the base of the tongue. The bulk at the base of the tongue is important to close off the oropharynx during swallowing with the assistance of the movement of hyoid bone. The rectus abdominis myocutaneous flap and the latissimus dorsi myocutaneous flap are alternative flap options. Motor nerve neurorrhaphy, selection of the free flap donor site, it's complication, and reconstruction method for TSCC will be discussed.