Onequarter to Onehalf Glossectomy of the Anterior Tongue

A 44-year-old patient had a T2N0 squamous cell cancer involving the right lateral tongue. The defect was estimated to be 4 x 4 cm isolated to the right mobile tongue with no associated floor of mouth defect. The goals were to maintain mobility of the remaining oral tongue and to optimize sensibility of the reconstructed segment.

The solution was to close the hemitongue defect primarily. Primary closure is usually possible for isolated defects involving up to 25% of the anterior tongue. Through-and-through defects of the floor of mouth should be reconstructed independently using a local, regional, or free flap. If the floor of mouth defect is not open to the neck, then a local flap or a skin graft should be used.

If primary closure is not possible, a split-thickness skin graft will suffice. If the floor of mouth is also involved associated with a through-and-through defect into the neck, a sensate radial forearm free flap may be used both to reconstruct the floor of the mouth and to resurface the tongue (Fig. 14). This defect combined with a man- ยป

dibular segmental defect is a difficult reconstructive challenge. The soft tissue components of the osseous free flaps are either too bulky or too tethered to provide d independent pliable tissue for the anterior tongue. Repairing posterior mandibular defects with a reconstruction plate may circumvent this. If the cutaneous component |

of the osseous flap is used, then secondary releasing procedures may be required.

One-staged reconstruction can be accomplished with dual free flaps using an osseous free flap combined with a radial forearm flap for the floor of mouth and tongue.

Figure 14 Combined defects of the lateral tongue and floor of mouth reconstructed with a sensate radial forearm free flap. Arrows depict the surface of the flap.
How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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