You Flap That Tongue at Me Again
Introduction
Squamous prison cell carcinoma of the oral cavity (OSCC) is i of the nigh ordinarily encountered malignancies of head and neck, and it accounts for more than than 90% of all cases of head and neck cancers [1]. In improver, OSCC is the sixth most common cancer in the earth and accounts for most 3% of all cancer cases, co-ordinate to 2017 global cancer statistics [two]. Tongue is a common site of OSCC with the subsequent loftier charge per unit of local or regional recurrence owing to the complexity of its structure [three]. Surgical removal of the affected side of the natural language, especially with T1 or early on T2 carcinoma, remains the main line of management of oral natural language squamous cell carcinoma (OTSCC) [4]. Notwithstanding, reconstruction of the resulted tongue defects through the chief closure of the remaining tongue or skin grafting may result in distorted natural language, and such distortion may significantly atomic number 82 to defective tongue ability to control nutrient and liquid in the oral cavity, salivary pooling, and spoken communication problems [5].
In the recent years, a novel technique for reconstruction of natural language defects through local natural language flap has been proposed [6]. The local tongue flap procedure is based mainly on the rotation of the remaining tongue, which offers restoration of a full-bodied mobile tongue. Lam et al. [vii] described a case with a 2-cm (T2N0M0) squamous cell carcinoma that involved the posterior right lateral border of the tongue, and the sliding anterior hemitongue flap resulted in a full-bodied tongue in the posterior oral cavity with excellent tongue mobility, voice communication ability, and swallowing.
In the nowadays prospective study, nosotros aimed to evaluate local tongue flap for reconstruction of posterolateral tongue defects afterwards partial glossectomy.
Patients and methods
We followed the recommendations of the Strengthening the Reporting of Cohort Studies in Surgery during the preparation of the nowadays prospective study [viii].
Ethical blessing
The report was conducted in accordance with the International Conference on Harmonization Good Clinical Practice guidelines, the Declaration of Helsinki, and applicative local regulatory requirements and laws. The study was approved by the Institutional Review Board of the Menoufia University Hospital.
Written report pattern and setting
We conducted a prospective accomplice study at Full general Surgery Section, Menoufia Academy Infirmary from May 2013 to January 2016.
Patients
In the present study, we recruited 17 patients who presented with tongue ulcers and were diagnosed with T1 or T2 OTSCC involving the posterior part of the tongue afterward incisional biopsy. Metastatic workup was done using radiological methods, and neck nodes assessment was done using ultrasound and computed tomography browse. Patients with more avant-garde lesions (T3 or T4) and those with previous tongue excision procedures were excluded.
Local tongue flap technique
Initially, patients underwent partial hemiglossectomy with acceptable margins (≥0.5 cm) of mucosa and soft tissue, and neck autopsy − if indicated − (Figs. one and ii). The remaining usable tongue was divided down through the genioglossus musculus at the median fibrous septum, and the divided office was carried anteriorly (Fig. 3). A curvilinear incision was and then extended to the contralateral inductive tongue and the remaining anterior half of the resected natural language was rotated along the curvilinear incision and moved posteriorly to exist sutured to the remaining of the posterior part of the natural language. The afflicted side was sutured to the unaffected side past ii layers.
- Partition of the remaining tongue forth the median septum.
- Preserving the inductive 3rd of the tongue.
- Rotation posteriorly along the curvilinear incision.
- Suturing the flap.
Shows the remaining tongue tissue.
Shows splitting of the tongue at lingual septum.
Postoperative afterward 2 weeks.
Postoperative assessment
Patients were given fluid on the first day after the functioning, followed past soft diet to the finish of the first calendar week. The regular feeding was then continued from the beginning of the week 2 (Fig. 4). The included patients were followed postoperatively and assessed for tongue healing and neck complications. The total duration of follow-up was 2 months (Fig. five), and the patients were assessed at the week i, week ii, one month, and 2 months postoperatively.
Postoperative after 6 months.
Local anterior tongue flap technique.
Statistical analysis
The statistical assay was carried with statistical package for the social sciences software (SPSS, version 24; SSPS Inc., Chicago, Illinois, Us). Frequency tables with percentages were used for categorical variables, and descriptive statistics (mean and SD) were used for numerical variables.
Results
The hateful historic period of included patients was 57.47±ix.53 years old, and the bulk of them were male (70%). Approximately half of them were either smokers or diabetic, and six patients were both smokers and diabetic. The hateful tumor size was two.04±0.85 cm. Tumors were locally excised with mean safety margins of i.06±0.48 cm. Overall, 64% of the patients with OTSCC underwent neck dissection, and the mean number of the positive lymph nodes was three±2.13. Tabular array 1 shows the characteristics of included patients.
The characteristics of included participants
Postoperatively, 82.5% of the patients exhibited a good tongue healing with adequate tongue function. Three (17.6) patients experienced natural language infection with partial dehiscence, which healed completely after 2 weeks with conservative treatment. Regarding neck complications, 17.6% of the patients had infections and dehiscence, whereas but two patients had seromas (Table ii).
Postoperative results
Word
Local natural language flap is a novel technique for the restoration of fully functioning natural language following fractional hemiglossectomy. In the present prospective study, local natural language flap was an effective technique for reconstruction of posterior tongue defects afterwards partial glossectomy of OTSCC. Most included patients (82.4%) exhibited a practiced tongue healing postoperatively, with a low rate of natural language infections which healed completely after conservative treatment.
The primary management of early OTSCC is based on fractional glossectomy, with or without neck autopsy. However, the subsequent tongue defects represent a reconstructive challenge that required special attention from the surgeon. Functional restoration is the primary goal of reconstruction of tongue defects through providing both bulk and mobility [4]. Currently, the most ordinarily used surgical options for reconstruction of fractional tongue defects are primary closure, skin grafting (either by full thickness or split thickness), pedicled flaps, and free flaps [9 ten]. However, there is a growing body of evidence that shows a defect in the restoration of fully functioning natural language with those techniques. A previous systematic review by Lam and Samman [eleven] reported a significant reject in speech and swallowing function following free flap reconstruction express to either the oral natural language or the base of tongue in early postoperative period; in addition, speech and swallowing outcomes were markedly declined following complimentary flap reconstruction involving both oral and base of tongue.
To overcome the limitations of the commonly used surgical options, local tongue flap was proposed to restore a fully bodied mobile tongue. Lam et al. [7] reported first-class tongue mobility, speech ability, and swallowing following sliding anterior hemitongue flap. Moreover, some other study showed that the sliding natural language flap, following partial glossectomy of T1/T2 cancers in the anterior half of the natural language, resulted in natural bilateral symmetry of the tongue and adept corrective appearance postoperatively [5]. The sliding posterior tongue flap of mid-tongue defect showed like results, equally well [12]. In the present prospective study, the local natural language flap was associated with high rate of good tongue healing and a limited number of wound infections.
Regarding postoperative complications, 17.six% of the patients in the present study had infections and dehiscence, whereas only two patients had seromas. This low charge per unit of neck complications is similar to rates associated with other reconstruction techniques, Nueangkhota et al. [thirteen] reported no incidence of wound dehiscence or infection following reconstruction of the tongue defect through nasolabial isle flap in 7 patients with small to moderate OTSCC.
Conclusion
Local tongue flap is an effective technique for reconstruction of posterolateral tongue defects later on fractional glossectomy. Local natural language flap is associated with high rate of adept healing and low rate of complications. Farther big-calibration studies are all the same needed to establish the effectiveness of this technique.
Fiscal back up and sponsorship
Nil.
Conflicts of interest
In that location are no conflicts of interest.
References
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7. Lam DK, Cheng A, Berty KE, Schmidt BL. Sliding anterior hemitongue flap for posterior tongue defect reconstruction J Oral Maxillofac Surg. 2012;70:2440–2444
8. Agha RA, Borrelli MR, Vella-Baldacchino Thou, Thavayogan R, Orgill DP, Pagano D, et al The STROCSS statement: strengthening the reporting of cohort studies in surgery Int J Surg. 2017;46:198–202
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11. Lam L, Samman Northward. Speech and swallowing following tongue cancer surgery. and gratuitous flap reconstruction − a systematic review Oral Oncol. 2013;49:507–524
12. Chicarilli ZN. Sliding posterior tongue flap Plast Reconstr Surg. 1987;79:697–700
13. Nueangkhota P, Liang YJ, Zheng GS, Su YX, Yang WF, Liao GQ. Reconstruction of tongue defects with the contralateral nasolabial island flap J Oral Maxillofac Surg. 2016;74:851–859
Keywords:
fractional glossectomy; reconstruction; tongue flap; tongue healing
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Source: https://journals.lww.com/ejos/Fulltext/2018/37030/Local_tongue_flap_for_posterolateral_tongue.11.aspx
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