2021 Volume 72 Issue 1 Pages 38-46
An operating field for the tongue base is difficult to obtain compared to other areas in the head and neck. This can lead to a variety of post-operative problems, including those related to swallowing and articulation, and cosmetic aspects. Broadly speaking, there are three approaches to the tongue base: the oral approach, cervical incision approach, and mandibular osteotomy approach. The oral approach offers a narrow operating field, the cervical incision approach incurs risks of decreased swallowing functions and sutural insufficiencies, and the mandibular osteotomy approach has issues of invasiveness and cosmetic aspects. The median lingual approach with setback tongue flap for carcinomas in the tongue base is a surgical procedure that involves moving the front portion of the tongue on the affected side to the back, reconstructing the base of the tongue after a median incision from the tongue tip, and extracting the carcinoma. Mobility and blood flow of both the base and tip of the tongue can be preserved, although not completely. At our clinic, we investigated the use of TOVS in superficial carcinomas below T2, the median lingual approach with set-back tongue flap if deep invasions were suspected on image findings, and a combination of FK retractor or cervical incision approaches if the carcinoma had progressed to the caudal or lateral sides. We report cases under the treatment strategy of our clinic, where favorable results were obtained with regard to the functional, cosmetic, or curative aspects using the tongue median approach with set-back tongue flap or combined approaches involving the previous method and an FK retractor. Taking into account the extent of progression of the carcinoma and general conditions, the present method can be considered a surgical procedure that assures a radical cure and minimizes functional disorders.
