Tongue Reconstruction: A Review Of The Literature And Algorithm For Optimizing Speech And Swallow Based On Defect Size
Haley A. Bunting, M.S., Michael V. DeFazio, M.D., John R. Barbour, M.D..
MEDSTAR GEORGETOWN UNIVERSITY HOSPITAL, Washington, DC, USA.
PURPOSE: Restoration of speech and swallowing are the primary goals following glossectomy. With multiple reconstructive options available, a comparison of functional outcomes will aid in selecting the optimal solution for a given defect. We propose an algorithm to optimize functional outcomes.
METHODS: A systematic review of Pubmed, Ovid and Cochrane databases was performed (Figure 1). Articles were evaluated for defect size, reconstruction type, sample size (n>5), and functional outcomes. Only studies with systematic and scalable methodology were included. Outcome averages were scaled and compared to formulate an algorithm that maximizes speech and swallowing.
RESULTS: Twenty-seven articles containing 529 patients were included. Multiple defect sizes were analyzed: partial glossectomy (n=131), hemiglossectomy (n=251), subtotal glossectomy (n=35) and total glossectomy (n=106). An algorithm was developed according to defect size (Figure 2).
CONCLUSIONS: For partial, hemi-, and subtotal glossectomy defects, functional outcomes are achieved with buccal myocutaneous, SFIF, and ALT flaps. ALT/RF free flaps should be used for total glossectomy defects. For defects less than 50%, local tissue rearrangement has proven superior. The ALT/RF free flaps provide better outcomes in larger defects compared to rectus abdominis and latissimis dorsi flaps. This establishes the most current review of functional outcomes following glossectomy reconstruction.
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