Trans–Oral Reconstruction of the Mobile Tongue Using the Radial Forearm Free Flap

Tongue resection has significant influence on the patient's quality of life, because it interferes with masticatory and speech functions and affects facial aesthetics. Hence, the authors'approach to reconstruction of the anterior tongue is to allow the residual tongue to maintain its maximum mobility by introducing a thin, pliable cutaneous free flap to restore its shape and volume. The purpose of this study was to share their experience of partial trans–oral anterior tongue resection, succeeded by trans–oral reconstruction, using a radial forearm free flap.

From 1999 to 2004, 15 patients underwent partial glossectomy, followed by trans–oral reconstruction using a radial forearm free flap. Patients were reviewed to determine their aesthetic and functional outcome as it related to speech, deglutition, and aspiration. All patients included in this study underwent resection of 40 to 50 percent of their mobile tongue, as well as reconstruction with a radial forearm free flap trans–orally without lip or mandibular split.

Mobile tongue reconstruction with RFFF was performed in 15patients. All flaps survived. All patients were followed up postoperatively for a minimum of 3 months. All returned to normal diet within 4 weeks. After 1 month of normal diet, all patients reported the ability to sense food that was trapped in the floor of the mouth on the side of the reconstruction. Patients who underwent resection and reconstruction of fully 50% of their mobile tongue had excellent cosmetic results. However, those who underwent resection of less than 50% of their mobile tongue had less satisfactory cosmetic results, due to some differences in height of the dorsal surface of the tongue.

The trans–oral approach, although technically demanding, preserves lip function as well as aesthetics, and seems to be an excellent option for resection and reconstruction of mobile tongue defects. Lip and/or mandibular split are obviously still needed for posterior or pharyngeal lesions, but as more experience with the trans–oral approach is gained, the envelope of trans–oral resection and reconstruction will be expanded to include more posterior and larger tumors.