Abstract
The tongue plays a key role in oral functions such as mastication, speech and deglutition. The current treatment strategies for tongue carcinomas are mainly surgery-based comprehensive therapies. The principal goals of tongue reconstruction are both resurfacing the surgical defects and restoration of these functions. As far as oral functions after glossectomy are concerned, speech intelligibility is positively correlated with masticatory and swallowing functions. Mobility and the shape of the oral tongue are essential for oral functions, and mobility and the volume of the base of the tongue are critical for completing the pharyngeal phase of swallowing.
Therefore, the most important point for obtaining satisfactory oral functions after partial or hemi-glossectomy is to maximize mobility of the residual tongue and to maintain its shape and position within the oral cavity by a thin, pliable flap, such as a radial forearm free flap. This offers the freedom of flap placement without tethering of the remaining tongue. When the lateral pharyngeal wall is excised in conjunction with glossectomy, a narrower faucial isthmus is recreated to facilitate the pharyngeal phase of swallowing.
When tumor resection largely involves the oral tongue, or largely involves both of the oral and base of the tongue, a wide and thick flap such as a rectus abdominis musculocutaneous free flap is used to reconstruct a tongue with a protuberant shape and sufficient volume. Ancillary procedures such as laryngeal suspension, laryngoplasty, epiglottopexy and cricopharyngeal myotomy may be advocated to prevent aspiration and to facilitate postoperative swallowing.
