Functional Outcomes of Oral Tongue Reconstruction: A Subjective Analysis

Background: Squamous cell carcinoma (SCC) of the oral tongue is an aggressive disease and mandates upfront surgery, appropriate reconstruction, and adjuvant therapy as indicated. Contemporary tongue reconstruction has been largely aided by free flaps, making it possible to tailor the flap precisely to the defect. Aims and Objectives: We aimed to assess functional outcomes of our post glossectomy patients subsequent to reconstruction and aimed to identify the flap types associated with the highest satisfaction rates. Methodology: We retrospectively evaluated a cohort of 145 patients with SCC of the oral tongue, who underwent glossectomy at our institution between March 2011 and July 2017. These patients had been reconstructed as per our volume-aided institutional algorithm with primary closure, radial forearm-free flap (RFFF), pectoralis major myocutaneous flap (PMMF), or anterolateral thigh-free flap. Appropriate analysis on surviving and functionally evaluable patients was done through a trilingual confidential IRB-validated phone administered questionnaire. Results: The subjective outcomes were most satisfactory for patients reconstructed with RFFF, which per our institutional algorithm forms the flap of choice for oral tongue volume restoration to the extent of 30%-50%; and also for primary closure, our preferred method for 0%-30% volume restoration. Subjective satisfaction with respect to speech and swallowing was the lowest when the PMMF was utilized for reconstruction. Notably, PMMF was only utilized for tongue reconstruction in severely comorbid patients. Conclusions: Oral tongue reconstruction should aim at restoration of mobility, structural support, restoration of bulk, and obviation of tracheotomy, among other aims. Primary closure for smaller defects and a skin-lined free flap for larger defects appear to be associated with high rates of subjective satisfaction across all parameters.