A novel 3-D design of double-paddle free radial forearm flap for tongue reconstruction after hemiglossectomy

A novel 3-D design of double-paddle free radial forearm flap for tongue reconstruction after hemiglossectomy

Shih-Hsin Chang¹  Yan-Bo Wang¹  Jeng-Chien Yang²

Plastic Reconstructive Surgery, Mackay Memorial Hospital, Taipei, Taiwan¹

Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan²

Purpose:

Our purpose was to develop a reconstruction that maximizes the mobility of the remaining tongue, maintains the volume to effectively obliterate the oral cavity and to develop a functional outcome measurement to speech and swallowing attributes.

Materials and Methods:

From July 2010 to June 2013, there were eleven patients with advance stage tongue cancer  who were treated with hemiglossectomy and one-stage reconstruction with double-paddle RFFF by the same team of head and neck surgeons and plastic surgeons. The shape and size of the double-paddle RFFF were designed based on the size of the tongue defect and the mouth floor.The tongue defect and the mouth floor defect were reconstructed separately by one skin paddle of RFFF. 10 patients of tongue cancer post-hemiglossectomy and free flap reconstruction underwent speech and swallowing rehablitation and the data were collected. The function of speech and swallowing were evaluated by speech therpaist at 12 months postoperatively following a standardized protocol.

Results:

All flap survived uneventfully and there was not major complication. Statistical analyses revealed that patients demonstrated a mild impairment in speech and swallow functioning after surgery. The motility of the tongue was good (Mean tongue elevation: 2 cm, mean tongue protrusion: 1.3 cm). The average rating score of articulation of speech was 4.9 and the average rating score of intelligibility of speech was 5.4.  There are no difference in function of speech and swallowing between two groups.

Conclusion:

The functional results are adequate and the double-paddled RFFF achieve the goals of tongue reconstruction with good mobility and satisfactory swallowing/speech function. We believe these modifications in flap design can lead to maximizing tongue mobility, which is critical in neotongue reconstruction.