Comparative Assessment of Total Versus Hemi Glossectomy Defects Reconstructed With Anterolateral Thigh Free Flap

Background: Free tissue transfers for reconstruction following tongue resection has become standard practice. Purpose: This study sought to evaluate volume shrinkage of the anterolateral thigh free (ALTF) reconstructing tongue defects at 6 months postoperative. The aim was to estimate a shrinkage factor for ALTF reconstructing hemi and total glossectomy. Study design, setting, sample: This was an IRB-approved retrospective cohort study conducted at the head and neck service at the University of Florida, College of Medicine, Jacksonville (FL). This study targeted patients with tongue cancer from January 2018 to April 2022. Inclusion criteria: patients with tongue squamous cell carcinoma (SCC) who were surgically treated by either hemi or total glossectomy and reconstructed with ALTF. Patients had to have a postoperative computer tomography scans at 1 and 6 months post-surgery. Patients with constant body mass index during 6 months postreconstruction. Additionally, the patients were to have been treated with adjuvant radiotherapy. Exclusion criteria: patients with recurrent tongue cancer and those who weren't reconstructed or managed with other treatment modalities. Predictor variable: Type of tongue resection hemi versus total glossectomy for treatment of tongue SCC. Main outcome variable: Shrinkage percentage of ALTF reconstructing tongue defects at 6 months postoperatively. Covariates: Age and gender. Analyses: Paired t -test and student t -test with level of significance P # .05 were used to statistically analyze ALTF volume changes at 1 and 6 months postoperatively and ALTF shrinkage percentage at 6 months postreconstruction, respectively. Results: We identified 85 patients who were treated for tongue SCC during the time period of study. Out of the 85 patients, 11 patients were reconstructed with an ALTF. Eight males and 3 females with a mean age of 62.3 years old. Six patients had total glossectomy and 5 had hemi glossectomy. Patients with hemi glos-sectomy had a significant difference in mean average flap shrinkage of 39.6%, while in those with total glos-sectomy had 17.7% (P = .004). Conclusion and Relevance: According to our results, we recommend that the flap size should be larger than the defect to adjust for volume shrinkage (1.4 times and 1.2 times for cases of hemi and total glossec-tomy, respectively).& COPY; 2023 American Association of Oral and Maxillofacial Surgeons