Investigating Neotongue Atrophy and Postoperative Outcomes in Patients Undergoing Glossectomy With Free Flap Tongue Reconstruction.

Abstract

Objective: Following glossectomy, tongue reconstruction via autologous free flap can reapproximate native form and function, significantly improving postoperative quality of life. Various studies have examined functional outcomes between the commonly employed radial forearm free flap (RFFF) and the anterolateral thigh free flap (ALTFF); however, changes in neotongue volumetric bulk are less clearly understood.

Study design: We aimed to assess postoperative outcomes and volume changes in patients undergoing glossectomy.

Setting: This is a retrospective chart review of patients who underwent glossectomy with reconstruction at a single academic center.

Methods: Patients who underwent hemiglossectomy with RFFF or ALTFF reconstruction were retrospectively identified. Patient demographics, past medical history, and treatment course were collected. Perioperative imaging was utilized to measure native tongue, tumor, and postoperative neotongue volumes.

Results: Of 35 patients identified, ALTFF patients presented with greater tumor stage and depth of invasion than RFFF patients. Volumetric analysis of 17 patients revealed a mean tongue size decrease of 31.68 cm³ (SD, 42.02). Correlational analyses revealed a significant negative relationship of tongue volume over time (Spearman coefficient = -0.52, P = .04). Length of time was significant independent of flap type or mass volume (F = 4.85, P = .046). No significant relationship was found between flap type, tumor size, and change in total tongue size. ALTFF patients trended towards a greater rate of percutaneous endoscopic gastrostomy (PEG) tube dependence than RFFF patients at 1 month, but by 3 months all patients tolerated oral intake; however, ALTFF patients demonstrated a smaller absolute reduction in body mass index (BMI) compared to RFFF patients.

Conclusion: Postoperative neotongue volume decreased in both the ALTFF and RFFF cohorts over time but was not impacted by flap type or tumor burden. Further research is warranted to understand the impact of flap design on neotongue atrophy.