Functional tongue and floor of mouth reconstruction with a chimeric flap after total glossectomy
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CASE REPORT
Functional tongue and floor of mouth reconstruction with a chimeric flap after total glossectomy Andrey P. Polyakov 1
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Alexander V. Mordovskiy 1
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Mikhail V. Ratushnyy 1
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Irina V. Rebrikova 1
Received: 20 April 2020 / Accepted: 11 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Presently, the functional reconstruction of the tongue in patients after subtotal or total glossectomy with the removal of the oral floor muscles and spearing of the larynx remains a complicated and unsolved issue. The aim of this case is to describe a method reconstruction of the tongue in patients after total glossectomy with the removal of the oral floor muscles using the chimeric latissimus dorsi and serratus anterior free flap (chimeric LD + SA flap) with motor innervation. Methods A 62-year-old woman with advanced cancer of the oral cavity was submitted to total glossectomy and then reconstruction with a chimeric LD + SA flap. With this method reconstruction of the tongue was made the creation a large mound (neotongue) lateral to the mandibular arch which can easily reach the palatal arch and also was made suspension of the larynx is essential given the ablative loss of supra-hyoid attachments. Results Our preliminary experience shows that this flap is a good reconstructive option for total glossectomy with the removal of the oral floor muscles and with larynx preservation. Functional and objective evaluation of the tongue reconstructed with chimeric LD + SA free flap requires further and standardized evaluation. Keywords Tongue cancer . Oral surgery . Reconstruction . Chimeric flap . Neotongue
The main method of treatment for patients with locally advanced cancer of the oral cavity is surgery. Oncological treatment of squamous cell cancer of the tongue requires aggressive surgical approach to provide R0 and reduce the risk of recurrence. Subtotal glossectomy and total glossectomy are surgical options in cases of advanced stage or recurrent carcinomas originating from the floor of mouth, the oral part of the tongue, or the base of the tongue [1]. The surgery for locally advanced cancer of the tongue includes the removal of the tumor within several anatomic areas, which leads to extensive defects in the oral cavity and is inevitably associated with the loss of necessary functions like swallowing and speaking. The anatomical resection dictates the reconstructive goals since functional outcomes vary based on the reconstructed region [2]. Injury to any oropharyngeal function creates a serious reconstructive challenge and major reductions in * Alexander V. Mordovskiy [email protected] 1
P. Hertsen Moscow Oncology Research Institute, National Medical Research Center for Radiology, Russian Ministry of Health, 2-nd Botkinsky 3, Moscow, Russia
quality of life (QoL) for the patient. Due to its multiple functions, complex biomechanics, and anatomical relationships of the tongue with the oropharyngeal cavity, reconstruction can be very challenging. The best results in terms of
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