The tongue is a muscular organ covered with a mucous membrane and located in the oral cavity. The tongue is composed of a number of muscles, which permit complex movement, used for both speech and eating. In addition, the taste buds are found exclusively in the tongue, and are located in the front two thirds of the tongue.

Malignant growths of the tongue or growths of the mucous membrane of the oral cavity which then infiltrate the tongue, are the main reason for its partial reconstruction. There are birth defects that involve the tongue, such as Down’s syndrome, which sometimes require reducing the tongue to match the size of the oral cavity and therefore improve functionality.

Reconstruction of the tongue usually means reconstructing the missing bulk in those cases where a small defect cannot be closed primarily. In such cases where the defect requires the reconstitution of the volume of the tongue, it is possible to use a flap, so a section of skin and fat tissue are transferred to the oral cavity and shaped locally to recreate the tongue tissue. In cases where the growth has spread further, it may involve other anatomical structures such as the floor of the mouth, the soft palate, and the throat.

A local flap that enables partial reconstruction of the tongue is the pectoralis major muscle, which is transferred to the oral cavity, along with a section of skin attached to it, through a subcutaneous tunnel in the neck. The skin connected to the muscle receives its blood supply from blood vessels that pass through the muscle, which serves only as a carrier. The section of skin is shaped within the oral cavity to fit the missing bulk, permitting optimal usage of the remaining tongue muscles. This reconstruction is used primarily in cases where it is not possible to use a free flap transplanted with its supplying blood vessels that are connected to recipient blood vessels in the neck.

Reconstruction of the tongue with free flaps is performed using flaps of skin and fat transferred from places like the forearm, the front of the thigh, the arm, the back, and others. The primary considerations in choosing the donor site are the size of the defect, the volume of the defect, the thickness of the fatty tissue of the flap, and the length of the blood vessels supplying it. In most cases, it is possible to close the donor area with a primary closure, though with the forearm it will be necessary to perform a skin graft.

The use of a free flap enables optimal fit of the reconstruction to the complex three-dimensional structure of the defect of the tongue and proximal structures, such as the throat and the soft palate.

It is worth mentioning that it is possible to transplant a muscle with its blood vessels and the nerve that activates it in a tongue reconstruction. The connection of the nerve to the amputated nerve that operates the tongue enables the renewed activity of the transplanted muscle within a few months. This reconstruction, however, is incapable of recapturing the complex movements of the tongue, and is not especially effective compared to a reconstruction performed with a transplanted skin and fat flap.

Dr. Aharon Amir: Tongue Reconstruction surgery

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