Dynamic Hemitongue Defect Reconstruction With Functional Gracilis Muscle Free Transfer

Area of Science:

• Head and Neck Surgery
• Reconstructive Surgery
• Speech and Swallowing Rehabilitation

Background:

• Hemiglossectomy, a partial tongue removal, often results in speech and swallowing difficulties due to the tongue's complex musculature.
• Conventional reconstruction with fasciocutaneous flaps offers limited functional recovery.
• This study investigates novel flap techniques for improved functional outcomes post-hemiglossectomy.

Purpose of the Study:

• To compare the functional recovery of patients undergoing hemiglossectomy reconstructed with different flap techniques.
• To evaluate the efficacy of conjoined free flaps (radial forearm flap and gracilis muscle flap) versus radial forearm flaps (RFFFs) or gracilis-only flaps.

Main Methods:

• A retrospective study of 23 patients who underwent hemiglossectomy and reconstruction between 2014 and 2019.
• Reconstruction methods included conjoined flaps (RFFF + gracilis), gracilis-only flaps, and RFFFs.
• Functional outcomes were assessed using videofluoroscopic swallowing studies, speech analysis, and a tongue movement scale.

Main Results:

• Conjoined flaps demonstrated superior lingual range of motion (elevation, lateralization) compared to RFFF-only reconstruction.
• Protrusion, elevation, and lateralization were better with conjoined flaps than gracilis-only flaps.
• Patients with conjoined flap reconstruction showed improved articulation, intelligibility, and dysphagia outcomes.

Conclusions:

• Conjoined free flap reconstruction, incorporating a radial forearm flap and a dynamic gracilis muscle flap, shows promise for enhancing postoperative tongue function after hemiglossectomy.
• This technique may lead to better speech and swallowing recovery.
• Further research is warranted to confirm these preliminary findings.