Journal of Plastic, Reconstructive & Aesthetic Surgery
Functional reconstruction of near total glossectomy defects using composite gastro omental-dynamic gracilis flaps
Section snippets
Patients and methods
This technique has been used in two patients in the last 18 months; the first patient was a 63-year-old female and the second, a 35-year-old male. Both patients underwent near total glossectomy for locally advanced squamous cell carcinoma of the tongue.
The first patient achieved good speech and swallowing but died 8 months later because of metastatic disease. The second patient is presently disease free and doing well clinically, 9 months after the procedure. Both patients underwent functional
Surgical technique
The procedure started with a bilateral neck dissection (Level I–IV).
Diagastric and mylohyoid muscles were divided near the mandible and near total glossectomy was performed by pull through into the neck, including all alveolar mucosa on the lingual side. A part of uninvolved base of the tongue was left behind. The right hypoglossal nerve was tagged with 6/0 prolene suture.
The gracilis muscle was tagged with sutures at 3 cm distance to judge the correct tension at the time of muscle fixation and
Tongue movements
On nine months follow up the patient has achieved good tongue movements with capability to touch the hard palate by voluntarily elevating the neotongue.
The patient's EMG recordings show innervation of the gracilis muscle with active generation of motor unit potentials when the patient tries to elevate the tongue (Figure 2 shows the baseline and Figure 3 shows the EMG on contraction). The appearance of the reconstructed tongue at the end of 6 months is very satisfactory (Figure 4).
Swallowing
The patient
Discussion
The priorities to be considered while reconstructing total or near total glossectomy patients are airway protection, swallowing and articulation. Previously, a multitude of techniques has been described in the literature to address this challenging problem. Initial attempts started from pedicled flaps that progressed to neurotised flaps using pectoralis major muscle.7 The drawbacks were constant downward pull of gravity on the tongue and the tethering effect of the flap.
The advances in
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