DOI QR코드

DOI QR Code

Evolution and current status of microsurgical tongue reconstruction, part II

  • Choi, Jong-Woo (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Alshomer, Feras (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young-Chul (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2022.08.18
  • Accepted : 2022.10.11
  • Published : 2022.10.20

Abstract

Tongue reconstruction remains a major aspect of head and neck reconstructive procedures. Surgeons planning tongue reconstruction should consider several factors to optimize the overall outcomes. Specifically, various technical aspects related to tongue reconstruction have been found to affect the outcomes. Multidisciplinary teams dedicated to oncologic, reconstructive, and rehabilitative approaches play an essential role in the reconstructive process. Moreover, operative planning addressing certain patient-related and defect-related factors is crucial for optimizing functional speech and swallowing, as well as quality of life outcomes. Furthermore, tongue reconstruction is a delicate process, in which overall functional outcomes result from proper flap selection and shaping, recipient vessel preparation and anastomosis, surgical approaches to flap insetting, and postoperative management. The second part of this review summarizes these factors in relation to tongue reconstruction.

Keywords

References

  1. Varkey P, Liu YT, Tan NC. Multidisciplinary treatment of head and neck cancer. Semin Plast Surg 2010;24:331-4. https://doi.org/10.1055/s-0030-1263075
  2. Ghazizadeh S, Kuan EC, Mallen-St Clair J, Abemayor E, Luu Q, Nabili V, et al. It takes two: one resects, one reconstructs. Otolaryngol Clin North Am 2017;50:747-53. https://doi.org/10.1016/j.otc.2017.03.010
  3. Torabi SJ, Chouairi F, Dinis J, Alperovich M. Head and neck reconstructive surgery: characterization of the one-team and two-team approaches. J Oral Maxillofac Surg 2020;78:295-304. https://doi.org/10.1016/j.joms.2019.09.011
  4. Wallace CG, Tsao CK, Wei FC. Role of multiple free flaps in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2014;22:140-6. https://doi.org/10.1097/MOO.0000000000000039
  5. Jeong WS, Oh TS. Oral and oropharyngeal reconstruction with a free flap. Arch Craniofac Surg 2016;17:45-50. https://doi.org/10.7181/acfs.2016.17.2.45
  6. Chung JH, Kim KJ, Jung KY, Baek SK, Park SH, Yoon ES. Recipient vessel selection for head and neck reconstruction: a 30-year experience in a single institution. Arch Craniofac Surg 2020;21:269-75. https://doi.org/10.7181/acfs.2020.00339
  7. Serletti JM, Higgins JP, Moran S, Orlando GS. Factors affecting outcome in free-tissue transfer in the elderly. Plast Reconstr Surg 2000;106:66-70. https://doi.org/10.1097/00006534-200007000-00012
  8. Bengtson BP, Schusterman MA, Baldwin BJ, Miller MJ, Reece GP, Kroll SS, et al. Influence of prior radiotherapy on the development of postoperative complications and success of free tissue transfers in head and neck cancer reconstruction. Am J Surg 1993;166:326-30. https://doi.org/10.1016/S0002-9610(05)80325-3
  9. Yagi S, Suyama Y, Fukuoka K, Takeuchi H, Kitano H. Recipient vessel selection in head and neck reconstruction based on the type of neck dissection. Yonago Acta Med 2016;59:159-62.
  10. Suh JM, Chung CH, Chang YJ. Head and neck reconstruction using free flaps: a 30-year medical record review. Arch Craniofac Surg 2021;22:38-44. https://doi.org/10.7181/acfs.2020.00745
  11. Engel H, Huang JJ, Lin CY, Lam W, Kao HK, Gazyakan E, et al. A strategic approach for tongue reconstruction to achieve predictable and improved functional and aesthetic outcomes. Plast Reconstr Surg 2010;126:1967-77. https://doi.org/10.1097/PRS.0b013e3181f44742
  12. Chen YC, Scaglioni MF, Huang EY, Kuo YR. Utility of "open-Y" anastomosis technique in the use of superior thyroid artery as recipient vessel for head and neck reconstruction with free flap. Microsurgery 2016;36:391-6. https://doi.org/10.1002/micr.22384
  13. Yamamoto Y, Nohira K, Kuwahara H, Sekido M, Furukawa H, Sugihara T. Superiority of end-to-side anastomosis with the internal jugular vein: the experience of 80 cases in head and neck microsurgical reconstruction. Br J Plast Surg 1999;52:88-91. https://doi.org/10.1054/bjps.1998.3037
  14. Chia HL, Wong CH, Tan BK, Tan KC, Ong YS. An algorithm for recipient vessel selection in microsurgical head and neck reconstruction. J Reconstr Microsurg 2011;27:47-56. https://doi.org/10.1055/s-0030-1267829
  15. Choi JW, Kim YC, Jeon DN, Jeong WS, Koh KS, Oh TS, et al. Impact of recipient vein selection on venous patency and free flap survival in 652 head and neck reconstructions. J Reconstr Microsurg 2020;36:73-81. https://doi.org/10.1055/s-0039-1695054
  16. Kim YC, Kim MJ, Kim HB, Kim SC, Choi JW. Impact of venous outflow pattern on flap compromise in head and neck reconstruction: review of 309 radial forearm free flaps. J Craniofac Surg 2019;30:1194-7. https://doi.org/10.1097/SCS.0000000000005281
  17. Guelinckx PJ, Boeckx WD, Fossion E, Gruwez JA. Scanning electron microscopy of irradiated recipient blood vessels in head and neck free flaps. Plast Reconstr Surg 1984;74:217-26. https://doi.org/10.1097/00006534-198408000-00008
  18. Ho AL, Lyonel Carre A, Patel KM. Oncologic reconstruction: general principles and techniques. J Surg Oncol 2016;113:852-64. https://doi.org/10.1002/jso.24206
  19. Abouyared M, Katz AP, Ein L, Ketner J, Sargi Z, Nicolli E, et al. Controversies in free tissue transfer for head and neck cancer: a review of the literature. Head Neck 2019;41:3457-63. https://doi.org/10.1002/hed.25853
  20. Kushida-Contreras BH, Manrique OJ, Gaxiola-Garcia MA. Head and neck reconstruction of the vessel-depleted neck: a systematic review of the literature. Ann Surg Oncol 2021;28:2882-95. https://doi.org/10.1245/s10434-021-09590-y
  21. Smit JM, Dimopoulou A, Liss AG, Zeebregts CJ, Kildal M, Whitaker IS, et al. Preoperative CT angiography reduces surgery time in perforator flap reconstruction. J Plast Reconstr Aesthet Surg 2009;62:1112-7. https://doi.org/10.1016/j.bjps.2007.12.090
  22. Kwon JG, Hong DW, Choi JW. Clinical applications of augmented reality technology in microsurgical planning of head and neck reconstruction. J Craniofac Surg 2022;33:863-6. https://doi.org/10.1097/SCS.0000000000008176
  23. Nahabedian MY, Singh N, Deune EG, Silverman R, Tufaro AP. Recipient vessel analysis for microvascular reconstruction of the head and neck. Ann Plast Surg 2004;52:148-55. https://doi.org/10.1097/01.sap.0000095409.32437.d4
  24. Tan BK, Wong CH, Chew W, Hong SW. Use of the slit arteriotomy for end-to-side arterial anastomosis in free-tissue transfers to the extremities. J Plast Reconstr Aesthet Surg 2009;62:1519-23. https://doi.org/10.1016/j.bjps.2008.05.016
  25. Yazar S. Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects. Microsurgery 2007;27:588-94. https://doi.org/10.1002/micr.20407
  26. Cheng HT, Lin FY, Chang SC. Evidence-based analysis of vein graft interposition in head and neck free flap reconstruction. Plast Reconstr Surg 2012;129:853e-854e. https://doi.org/10.1097/PRS.0b013e31824a6313
  27. Zhang T, Lubek J, Salama A, Caccamese J, Coletti D, Dyalram D, et al. Venous anastomoses using microvascular coupler in free flap head and neck reconstruction. J Oral Maxillofac Surg 2012;70:992-6. https://doi.org/10.1016/j.joms.2011.02.111
  28. Assoumane A, Wang L, Liu K, Shang ZJ. Use of couplers for vascular anastomoses in 601 free flaps for reconstruction of defects of the head and neck: technique and two-year retrospective clinical study. Br J Oral Maxillofac Surg 2017;55:461-4. https://doi.org/10.1016/j.bjoms.2016.10.001
  29. Frederick JW, Sweeny L, Carroll WR, Rosenthal EL. Microvascular anastomotic coupler assessment in head and neck reconstruction. Otolaryngol Head Neck Surg 2013;149:67-70. https://doi.org/10.1177/0194599813486875
  30. Thorpe E, Patil Y. Mechanical venous anastomosis in head and neck microvascular reconstruction as an equivalent to the gold standard. Ear Nose Throat J 2017;96:E32-6. https://doi.org/10.1177/014556131709600217
  31. Rozen WM, Whitaker IS, Acosta R. Venous coupler for freeflap anastomosis: outcomes of 1,000 cases. Anticancer Res 2010;30:1293-4.
  32. Hsiao HT, Leu YS, Lin CC. Tongue reconstruction with free radial forearm flap after hemiglossectomy: a functional assessment. J Reconstr Microsurg 2003;19:137-42. https://doi.org/10.1055/s-2003-39824
  33. Davison SP, Grant NN, Schwarz KA, Iorio ML. Maximizing flap inset for tongue reconstruction. Plast Reconstr Surg 2008;121:1982-5. https://doi.org/10.1097/PRS.0b013e318171237b
  34. Chiu T, Burd A. Our technique of "tongue" folding. Plast Reconstr Surg 2009;123:426-7. https://doi.org/10.1097/PRS.0b013e3181904e5b
  35. Chepeha DB, Teknos TN, Shargorodsky J, Sacco AG, Lyden T, Prince ME, et al. Rectangle tongue template for reconstruction of the hemiglossectomy defect. Arch Otolaryngol Head Neck Surg 2008;134:993-8. https://doi.org/10.1001/archotol.134.9.993
  36. Choi JW, Lee MY, Oh TS. The application of multilobed flap designs for anatomic and functional oropharyngeal reconstructions. J Craniofac Surg 2013;24:2091-7. https://doi.org/10.1097/SCS.0b013e3182a2442c
  37. Seikaly H, Rieger J, O'Connell D, Ansari K, Alqahtani K, Harris J. Beavertail modification of the radial forearm free flap in base of tongue reconstruction: technique and functional outcomes. Head Neck 2009;31:213-9. https://doi.org/10.1002/hed.20953
  38. Dziegielewski PT, Rieger J, Shama MA, O'Connell DA, Harris JR, Seikaly H. Beavertail modification of the radial forearm free flap in total oral glossectomy reconstruction: technique and functional outcomes. Oral Oncol 2019;96:71-6. https://doi.org/10.1016/j.oraloncology.2019.07.004
  39. Longo B, Pagnoni M, Ferri G, Morello R, Santanelli F. The mushroom-shaped anterolateral thigh perforator flap for subtotal tongue reconstruction. Plast Reconstr Surg 2013;132:656-65. https://doi.org/10.1097/PRS.0b013e31829acf84
  40. Zhou X, He ZJ, Su YX, Zhang S, Gong ZJ, Wu HJ. "Sushi roll" technique for precise total tongue functional reconstruction using a pre-sutured femoral anterolateral myocutaneous flap. Oral Oncol 2020;110:104866. https://doi.org/10.1016/j.oraloncology.2020.104866
  41. Selber JC, Robinson J. The manta ray flap: a technique for total glossectomy reconstruction. Plast Reconstr Surg 2014;134:341e-344e. https://doi.org/10.1097/PRS.0000000000000315
  42. Sakuraba M, Asano T, Miyamoto S, Hayashi R, Yamazaki M, Miyazaki M, et al. A new flap design for tongue reconstruction after total or subtotal glossectomy in thin patients. J Plast Reconstr Aesthet Surg 2009;62:795-9. https://doi.org/10.1016/j.bjps.2007.09.056
  43. Choi JW, Park JS, Kim JH. Extensive facial reconstruction using thickness-controlled perforator free flaps. Plast Reconstr Surg Glob Open 2020;8:e3210. https://doi.org/10.1097/GOX.0000000000003210
  44. Koumoullis H, Burley O, Kyzas P. Patient-specific soft tissue reconstruction: an IDEAL stage I report of hemiglossectomy reconstruction and introduction of the PANSOFOS flap. Br J Oral Maxillofac Surg 2020;58:681-6. https://doi.org/10.1016/j.bjoms.2020.04.017
  45. Shah JP, Gil Z. Current concepts in management of oral cancer: surgery. Oral Oncol 2009;45:394-401. https://doi.org/10.1016/j.oraloncology.2008.05.017
  46. Satpathy S, Dam A, Hossain MA, Chatterjee J. Double mandibular osteotomy with segmental mandibular swing approach to parapharyngeal space. Natl J Maxillofac Surg 2014;5:213-6. https://doi.org/10.4103/0975-5950.154840
  47. Scheithauer MO, Bohn JC, Riechelmann H. Median sagittal mandibulotomy in head-neck tumors. Laryngorhinootologie 2000;79:490-7. https://doi.org/10.1055/s-2000-5910
  48. Dziegielewski PT, Mlynarek AM, Dimitry J, Harris JR, Seikaly H. The mandibulotomy: friend or foe? Safety outcomes and literature review. Laryngoscope 2009;119:2369-75. https://doi.org/10.1002/lary.20694
  49. Holsinger FC, Laccourreye O, Weber RS. Surgical approaches for cancer of the oropharynx. Oper Tech Otolayngol Head Neck Surg 2005;16:40-8. https://doi.org/10.1016/j.otot.2005.02.001
  50. Civantos F, Wenig BL. Transhyoid resection of tongue base and tonsil tumors. Otolaryngol Head Neck Surg 1994;111:59-62. https://doi.org/10.1177/019459989411100112
  51. Pang P, Li RW, Shi JP, Xu ZF, Duan WY, Liu FY, et al. A comparison of mandible preservation method and mandibulotomy approach in oral and oropharyngeal cancer: a meta-analysis. Oral Oncol 2016;63:52-60. https://doi.org/10.1016/j.oraloncology.2016.11.004
  52. Cheng SJ, Ko HH, Lee JJ, Kok SH. Comparison of long-term outcomes between pull-through resection and mandibular lipsplit surgery for T4a tongue/floor of mouth cancers. Head Neck 2018;40:144-53. https://doi.org/10.1002/hed.24994
  53. Li H, Li J, Yang B, Su M, Xing R, Han Z. Mandibular lingual release versus mandibular lip-split approach for expanded resection of middle-late tongue cancer: a case-control study. J Craniomaxillofac Surg 2015;43:1054-8. https://doi.org/10.1016/j.jcms.2015.05.008
  54. Liu CJ, Fang KH, Chang CC, Lin ET, Chang GH, Shen JH, et al. Application of "parachute" technique for free flap reconstruction in advanced tongue cancer after ablation without lipjaw splitting: a retrospective case study. Medicine (Baltimore) 2019;98:e16728. https://doi.org/10.1097/MD.0000000000016728
  55. Aubry K, Yachine M, Perez AF, Vivent M, Lerat J, Scomparin A, et al. Transoral robotic surgery for head and neck cancer: a series of 17 cases. Eur Ann Otorhinolaryngol Head Neck Dis 2011;128:290-6. https://doi.org/10.1016/j.anorl.2011.05.002
  56. O'Malley BW Jr, Weinstein GS, Snyder W, Hockstein NG. Transoral robotic surgery (TORS) for base of tongue neoplasms. Laryngoscope 2006;116:1465-72. https://doi.org/10.1097/01.mlg.0000227184.90514.1a
  57. Genden EM, Desai S, Sung CK. Transoral robotic surgery for the management of head and neck cancer: a preliminary experience. Head Neck 2009;31:283-9. https://doi.org/10.1002/hed.20972
  58. Kowalski LP, Lira RB. Anatomy, technique, and results of robotic retroauricular approach to neck dissection. Anat Rec (Hoboken) 2021;304:1235-41. https://doi.org/10.1002/ar.24621
  59. Park YM, Lee WJ, Yun IS, Lee DW, Lew DH, Lee JM, et al. Free flap reconstruction after robot-assisted neck dissection via a modified face-lift or retroauricular approach. Ann Surg Oncol 2013;20:891-8. https://doi.org/10.1245/s10434-012-2731-6
  60. Park ES, Shum JW, Bui TG, Bell RB, Dierks EJ. Robotic surgery: a new approach to tumors of the tongue base, oropharynx, and hypopharynx. Oral Maxillofac Surg Clin North Am 2013;25:49-59. https://doi.org/10.1016/j.coms.2012.11.002
  61. Mercante G, Ruscito P, Pellini R, Cristalli G, Spriano G. Transoral robotic surgery (TORS) for tongue base tumours. Acta Otorhinolaryngol Ital 2013;33:230-5.
  62. de Almeida JR, Park RC, Genden EM. Reconstruction of transoral robotic surgery defects: principles and techniques. J Reconstr Microsurg 2012;28:465-72. https://doi.org/10.1055/s-0032-1313762
  63. Smith JE, Suh JD, Erman A, Nabili V, Chhetri DK, Blackwell KE. Risk factors predicting aspiration after free flap reconstruction of oral cavity and oropharyngeal defects. Arch Otolaryngol Head Neck Surg 2008;134:1205-8. https://doi.org/10.1001/archotol.134.11.1205
  64. Meccariello G, Montevecchi F, Sgarzani R, Vicini C. Defectoriented reconstruction after transoral robotic surgery for oropharyngeal cancer: a case series and review of the literature. Acta Otorhinolaryngol Ital 2018;38:569-74. https://doi.org/10.14639/0392-100X-1473
  65. Song HG, Yun IS, Lee WJ, Lew DH, Rah DK. Robot-assisted free flap in head and neck reconstruction. Arch Plast Surg 2013;40:353-8 https://doi.org/10.5999/aps.2013.40.4.353
  66. Chalmers R, Schlabe J, Yeung E, Kerawala C, Cascarini L, Paleri V. Robot-assisted reconstruction in head and neck surgical oncology: the evolving role of the reconstructive microsurgeon. ORL J Otorhinolaryngol Relat Spec 2018;80:178-85. https://doi.org/10.1159/000492787
  67. Lai CS, Lu CT, Liu SA, Tsai YC, Chen YW, Chen IC. Robot-assisted microvascular anastomosis in head and neck free flap reconstruction: preliminary experiences and results. Microsurgery 2019;39:715-20. https://doi.org/10.1002/micr.30458
  68. Mercante G, Masiello A, Sperduti I, Cristalli G, Pellini R, Spriano G. Quality of life and functional evaluation in patients with tongue base tumors treated exclusively with transoral robotic surgery: a 1-year follow-up study. J Craniomaxillofac Surg 2015;43:1561-6. https://doi.org/10.1016/j.jcms.2015.06.024
  69. Salmon KM, Ruiz C, Cognetti DM, Curry JM, Luginbuhl AJ, Bar-Ad V, et al. Functional swallow-related outcomes following transoral robotic surgery for base of tongue carcinoma. Dysphagia 2022;37:28-36. https://doi.org/10.1007/s00455-021-10246-y
  70. Biron VL, O'Connell DA, Barber B, Clark JM, Andrews C, Jeffery CC, et al. Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis. J Otolaryngol Head Neck Surg 2017;46:20. https://doi.org/10.1186/s40463-017-0196-0
  71. Manrique OJ, Leland HA, Langevin CJ, Wong A, Carey JN, Ciudad P, et al. Optimizing outcomes following total and subtotal tongue reconstruction: a systematic review of the contemporary literature. J Reconstr Microsurg 2017;33:103-11.
  72. Vincent A, Kohlert S, Lee TS, Inman J, Ducic Y. Free-flap reconstruction of the tongue. Semin Plast Surg 2019;33:38-45. https://doi.org/10.1055/s-0039-1677789
  73. Chen DW, Wang T, Shey-Sen Ni J, Sandulache VC, Graboyes EM, Worley M, et al. Prognostic factors associated with achieving total oral diet after glossectomy with microvascular free tissue transfer reconstruction. Oral Oncol 2019;92:59-66. https://doi.org/10.1016/j.oraloncology.2019.03.005
  74. Murphy BA, Gilbert J. Dysphagia in head and neck cancer patients treated with radiation: assessment, sequelae, and rehabilitation. Semin Radiat Oncol 2009;19:35-42. https://doi.org/10.1016/j.semradonc.2008.09.007
  75. Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Gaziano J, Stachowiak L, et al. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck 2008;30:148-58. https://doi.org/10.1002/hed.20672
  76. Karlsson T, Johansson M, Andrell P, Finizia C. Effects of voice rehabilitation on health-related quality of life, communication and voice in laryngeal cancer patients treated with radiotherapy: a randomised controlled trial. Acta Oncol 2015;54:1017-24. https://doi.org/10.3109/0284186X.2014.995773
  77. van Gogh CD, Verdonck-de Leeuw IM, Langendijk JA, Kuik DJ, Mahieu HF. Long-term efficacy of voice therapy in patients with voice problems after treatment of early glottic cancer. J Voice 2012;26:398-401. https://doi.org/10.1016/j.jvoice.2011.06.002
  78. Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, et al. Guidelines for the surgical management of oral cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2019;12:107-44. https://doi.org/10.21053/ceo.2018.01816
  79. Vega C, Leon X, Cervelli D, Pons G, Lopez S, Fernandez M, et al. Total or subtotal glossectomy with microsurgical reconstruction: functional and oncological results. Microsurgery 2011;31:517-23. https://doi.org/10.1002/micr.20922