Dynamic tongue reconstruction with innervated gracilis musculocutaneos flap after total glossectomy

Laryngoscope. 2019 Jan;129(1):76-81. doi: 10.1002/lary.27176. Epub 2018 Oct 16.


Objective: Advanced tongue cancer treated with total glossectomy with laryngeal preservation (TGLP) has a high risk of severe postoperative morbidity due to the loss of swallowing and articulation ability. The purpose of our work is to highlight the potential of the innervated gracilis musculocutaneous flap (IGMF) to permit a good quality of life in patients after undergoing this kind of surgery, particularly when associated with an adequate rehabilitation course.

Methods: We are presenting a cohort of 15 patients with T3 or T4 tongue cancer treated with TGLP and dynamic reconstruction with IGMF between 1998 and 2016. Functional outcome data were collected employing flexible endoscopic examination of swallowing, as well as swallowing and speech tests and questionnaires. Our reconstructive procedure was compared with different techniques described in the literature.

Results: In 13 out of 15 patients, a positive functional outcome was recorded, defined as the achievement of an adequate swallowing and speech ability. In two patients, the lack of success was caused by the flap's necrosis and death from early pulmonary metastasis. Of 13 patients, 12 were still alive after 2 years. Ten patients regained an independent feeding by mouth for normal food, whereas three patients continued percutaneous endoscopic gastrotomy supplementation. After 40 months, all 13 patients displayed a moderately intelligible speech capability.

Conclusion: Although TGLP can have devastating morbid effects, an appropriate dynamic reconstruction-along with an adequate course of rehabilitation-can provide good swallowing and articulation outcomes, which permit a satisfactory long-term quality of life.

Level of evidence: 4 Laryngoscope, 129:76-81, 2019.

Keywords: Tongue cancer; dynamic tongue reconstruction; innervated gracilis musculocutaneous flap; laryngeal preservation; total glossectomy.

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / surgery
  • Deglutition
  • Female
  • Glossectomy / methods*
  • Gracilis Muscle / transplantation*
  • Humans
  • Male
  • Middle Aged
  • Myocutaneous Flap / innervation*
  • Postoperative Period
  • Reconstructive Surgical Procedures / methods*
  • Speech
  • Tongue / surgery
  • Tongue Neoplasms / surgery*
  • Treatment Outcome