Tongue Flaps

Tongue flaps are very useful local flaps for intraoral reconstruction

1. Department of Plastic And Reconstructive Surgery Sher-i-Kashmir Institute of Medical Sciences(SKIMS), Srinagar Seminar Topic: Tongue Flaps

2. Tongue Flaps Presentor : Dr Junaid khurshid Moderator : Dr P Umar Farooq Baba

3. History Tongue flaps introduced by lexer in 1909 Properrties Relaible Easily obtanable Excellent vascularity Large ammount of tissue Usually for large defects

4. Intra oral flaps Tongue flap Buccal flap Palatal flap

5. Indications Moderate size defect 3 to 5 cm Defects where bone is exposed eg marginal mandibulectomy Defects close to RMT High risk patients Repair of large fistulas in palate

6. Posterior based dorsal flaps

7. Used for Surgical defects of wide local excision Marginal mandibulectomy Buccal mucosa defect post early carcinoma excision It does not limit mobility of tongue Primary closure of donor area Single stage procedure Based on dorsal lingual artery

8. Anterior based dorsal flap

9. Offer greater mobility More versatile Anterior cheek and commissural defect Can replace lining and vermilion of lips Floor of mouth Oronasal defects in cleft lip Excisional defects of hard pallate Needs secound stage surgery

10. Transverse dorsal tongue flap

11. Based on branches of dorsal lingual artery Layer of intrinsic muscle included in flap Usually created in bi pedicle form Transferred to floor of mouth Decrease length of tongue

12. Perimeter flap

13. Perimeter flap developed by vertical incision just inside and parallel to border of tongue these flaps can be uni or b I pedicle Repair of lip vermilion defects Highly vascular by anastomotic ranine arch

14. Dorsoventral flap

15. Derived from lingual tip by horizontal incision Are wide then long Reflected dorsally for upper lip reconstruction Reflected ventrally on anterior base for lower lip reconstruction Tongue shortening

16. Ventral based flaps

17. Repair of anterior floor of mouth Two parallel lengthwise posterior based flaps are reflected and rotated to anterior defect Resultant defect skin grafted For vermilion recon also

18. Sliding Anterior Hemitongue Flap for Posterior Tongue Defect Reconstruction

19. Posterior tongue defects present a unique reconstructive challenge A novel sliding anterior hemitongue flap to allow reconstruction of moderate resection defects (i.e. for T1-T2 tongue squamous cell carcinomas)  Lateral orientation of lingual; neurovascular allows division of remaining tongue through the median fibrous septum

20. Case 1 Anteriorly Based Tongue Flap for Closure of a Posterior Palatal Defect in a Patient with Exaggerated Gag Reflex

21. 3 X 2 cm defect of left soft palate. Dense scar tissue formation at left margin from previous skin grafts at time of ablative surgery.

22. Anteriorly based tongue flap raised showing muscle thickness utilized

23. Flap base inset into donor site.

24. 7 months post op. Good integration of the flap with no signs of residual fistula formation. Uvula is midline and the flap is well vascularized.

25. Asessment Flap viability Fistula closure Residual tongue function Asthetics Asessment of speech impediment

26. Speech assessment Articulation Speech intelligibility Nasal emission Hypernasality Findings documented by speech pathologist

27. case 2  A laterally based posterior tongue flap being utilized for left maxillary oral-antral communication closure

28. Case 3   A dorsal anteriorly based tongue flap being used for left maxillary oral-antral communication

29. Case 4 Anterior based dorsal flap for anterior palatal fistula

30. Summary Tongue flaps have been used in the field of oral and maxillofacial reconstruction over the past 100 year In 1909, Lexer documented the first use of a posteriorly based dorsal tongue flap for the management of retro-molar and tonsillar defects . Tongue flaps have a long standing history in oral and maxillofacial reconstruction E xtremely successful with minimal morbidity.

31. Thank you