Tongue prosthesis after total glossectomy: a case report.

Squamous cell carcinoma (SCC) is the type of cancer that most frequently affects the oral cavity, mainly in men older than 50 years of age. Treatment for oral SCC often involves surgical excision of the affected margins, resulting in mutilation that affects the patient's quality of life. The objective of this case report is to describe the prosthetic treatment of a 56-year-old man who underwent total glossectomy, resulting in speech and swallowing difficulties. The proposed treatment was a tongue prosthesis retained by orthodontic clasps on the mandibular first molars. After maxillary and mandibular complete-arch impressions were performed and casts were prepared for prosthetic planning, an acrylic resin plate and 3 tongue prototypes were fabricated. Esthetic and functional tests were carried out, and 2 tongue models (1 for speech and 1 for eating) were selected for acrylization, finishing, and polishing. After placement of the prostheses, the patient was referred for follow-up with a speech therapist to improve his adaptation with the prostheses. The patient was satisfied with the prostheses and able to perform the functions of chewing, swallowing, and speech production, which helped in his social reintegration and improved his quality of life.

Algorithmically designed flaps in tongue reconstruction: a feasibility analysis.

PURPOSE: Despite the significance and complexity of tongue reconstruction surgery, a digital tool for flap design is currently lacking. This study investigates the effectiveness of employing inverse finite element method (IFEM) for meticulously designing the geometric characteristics of harvested tissue (free flap) for tongue reconstruction. METHODS: In the case of an artificially simulated hemiglossectomy, IFEM algorithm was applied for algorithmic flap design. The method's effectiveness was evaluated by assessing flap deformation in a simplified virtual reconstruction, focusing on parameters such as stress, strain, and thickness. RESULTS: The IFEM algorithm successfully generated an optimal flap design for the intended surgical removal. Analysis of the flap's overall surface area, deformation characteristics, and safety margins demonstrated the feasibility of the deformation. Notably, the stress and thickness assessments suggested that the flap's tension post-surgery would not adversely affect the mobility of the reconstructed tongue, suggesting a positive outcome for functional recovery. CONCLUSION: The IFEM demonstrates significant potential as a tool for precise free flap design in tongue reconstruction surgeries. Its application could lead to improved surgical accuracy and better quality of life for patients undergoing such procedures.

Quantifying Articulatory Working Space in Individuals Surgically Treated for Oral Cancer With Electromagnetic Articulography.

PURPOSE: The purpose of this study was to quantify sentence-level articulatory kinematics in individuals treated for oral squamous cell carcinoma (ITOC) compared to control speakers while also assessing the effect of treatment site (jaw vs. tongue). Furthermore, this study aimed to assess the relation between articulatory-kinematic measures and self-reported speech problems. METHOD: Articulatory-kinematic data from the tongue tip, tongue back, and jaw were collected using electromagnetic articulography in nine Dutch ITOC and eight control speakers. To quantify articulatory kinematics, the two-dimensional articulatory working space (AWS; in mm2), one-dimensional anteroposterior range of motion (AP-ROM; in mm), and superior-inferior range of motion (SI-ROM in mm) were calculated and examined. Self-reported speech problems were assessed with the Speech Handicap Index (SHI). RESULTS: Compared to a sex-matched control group, ITOC showed significantly smaller AWS, AP-ROM, and SI-ROM for both the tongue tip and tongue back sensor, but no significant differences were observed for the jaw sensor. This pattern was found for both individuals treated for tongue and jaw tumors. Moderate nonsignificant correlations were found between the SHI and the AWS of the tongue back and jaw sensors. CONCLUSIONS: Despite large individual variation, ITOC showed reduced one- and two-dimensional tongue, but not jaw, movements compared to control speakers and treatment for tongue and jaw tumors resulted in smaller tongue movements. A larger sample size is needed to establish a more generalizable connection between the AWS and the SHI. Further research should explore how these kinematic changes in ITOC are related to acoustic and perceptual measures of speech.

Painful refractory erosive tongue lichen planus with malignant transformation.

We present a recent case of long standing erosive tongue lichen planus successfully treated by wide excision and reconstruction with a submental artery island flap. Erosive Lichen Planus is a progressive indolent potentially malignant condition that tends to end up with severe somatic or even neuropathic pain and malignant changes towards its final stages as elaborated in the presented commentary.

How to do a single-stage perforator based nasolabial flap for reconstruction of early-stage tongue cancer.

Tongue cancers are one of the most common subsites of malignancy in the head and neck, of which the majority are squamous cell carcinoma (SCC). Reconstruction following ablative surgery is challenging because of the role of the tongue in articulation, deglutition and protection of the airway. Microvascular free flaps are the current gold standard of reconstruction but are not feasible in all patients. Local and regional flaps provide a less challenging, faster alternative and may be more appropriate in comorbid patients with high anaesthetic risk as well as those with previously irradiated neck and poor vasculature. Nasolabial flaps are not commonly used for tongue reconstruction, requiring a two-staged procedure to allow division of the pedicle. We submit a modification of nasolabial flap as an inferiorly based, islanded perforator flap. This allows for single-stage reconstruction of tongue and floor of the mouth defects following resection of early-stage tongue cancers.

Predicting the Outcomes of Oropharyngeal Surgery in Patients With Obstructive Sleep Apnea Using Tongue-Retaining Devices.

OBJECTIVE: To determine the efficacy of a tongue-retaining device (TRD) in predicting the outcomes of oropharyngeal surgery in patients with obstructive sleep apnea (OSA) before surgery. STUDY DESIGN: A prospective case-control study. SETTING: A single tertiary medical center. METHODS: Patients with moderate-severe OSA who underwent both uvulopalatopharyngoplasty and tongue base suspension between January 2022 and July 2022 were included. Each patient underwent a series of 3 overnight polysomnography. Objective outcomes include apnea-hypopnea index (AHI), minimal oxygen saturation, and reduction rate of AHI. The correlation between the reduction rate of AHI with TRD and surgery was analyzed with linear regression. RESULTS: The reduction rates of AHI were significantly different between the group using TRD (44 ± 24%) and the postoperative group (55 ± 21%). The cross-tabulation revealed a strong association between a positive response to TRD treatment and a positive response to surgery. The use of TRD to evaluate surgical response demonstrated a positive predictive value of 90% and a negative predictive value of 70%. A strong correlation between the decrease in AHI was observed in both TRD and surgery groups, which was demonstrated by a steep slope in the scatter plot and a significant simple linear regression line. CONCLUSION: Preoperative TRD response is an accurate tool for predicting the success of oropharyngeal surgery in managing OSA patients before surgical treatment. Furthermore, a quantifiable positive linear correlation exists between the efficacy of preoperative TRD treatment and surgery.

Transoral Endoscopy-Assisted Tongue-Lip Adhesion With Modified Tongue Base Suspension in a Pierre-Robin Sequence: A Safe and Effective Technique.

Life-threatening airway obstruction is a major concern in patients with Pierre-Robin sequence. Tongue-lip adhesion (TLA) has been used to manage airway obstruction. The authors present the case of a female neonate with Pierre-Robin sequence who presented with airway obstruction and a cleft palate. She underwent a TLA procedure with modified tongue base suspension (TBS). Endoscopy was used to check and control the traction of the tongue base to enable unobstructed self-ventilation. Positive outcomes including improved O2 saturation and weight gain were noted. The effectiveness of TLA was enhanced by using TBS with real-time endoscopy to evaluate the oropharyngeal airway space required to alleviate airway obstruction. The use of endoscopy enabled us to check and determine how much the tongue base should be tracted by manipulating the tongue anteriorly and posteriorly. The authors report transoral endoscopy-assisted TLA and modified TBS.

A Pilot Study: Free Flap Atrophy in Tongue Reconstruction Using 3D Volumetric Analysis.

OBJECTIVE: To identify factors influencing volume change in non-osseous oral free flap reconstruction using postoperative cross-sectional imaging and 3-dimensional segmentation of the free flap's muscular and adipose tissue content. METHODS: Oral tongue free flap reconstruction cases (2014-2019) were reviewed with inclusion of patients with 3 postoperative, cross-sectional imaging studies with 1 within 6 months, 1 within 1 year, and 1 that spanned 2 years post-reconstruction. Exclusion criteria included recurrence, significant dental artifact, bony reconstruction, and flap failure. Demographics, risk factors, and surgical/clinical treatments were identified. Flap volumes were measured using Materialise MIMICS. RESULTS: Twenty-two patients met strict inclusion criteria. Four flaps were anterolateral thighs and 18 radial forearms. Median percent volume loss greater than 2 years post-reconstruction was 53.2% overall, 58.1% for radial forearms, and 45.4% for ALTs (21.4% for adipose tissue and 57.4% for muscular tissue). Univariate analysis revealed glossectomy amount was associated with percent volume loss (P = .0417). Each successive postoperative month, the flap decreased by 1.54% (P < .0001). Checking for the interaction effect, the percent of flap loss across time was different for glossectomy amount (P = .0093), obesity status (P = .0431), and base of tongue involvement (P = .0472). CONCLUSION: Glossectomy type, and thus flap size, is a positive predictor for flap atrophy. Obesity and base of tongue involvement are negative predictors for flap atrophy. The amount of tissue loss may differ from classical teachings with median atrophy 53.2% greater than 2 years post-reconstruction.

Structural analysis of the mylohyoid muscle as a septum dividing the floor of the oral cavity for the purposes of dental implant surgery: variety of muscle attachment positions and ranges of distribution.

OBJECTIVES: The objective was to investigate the details of the attachments of the mylohyoid muscle to the mandible anterior to the hyoid and mylohyoid lines to understand the positional relationship between the sublingual space and the mylohyoid, knowledge that is essential for dental implant surgery in the incisal region, as well as the routes of communication between the sublingual space and other spaces. METHODS: While evaluating the presence or absence of an anterior mylohyoid muscle fiber attachment to the mandible, sublingual gland herniation, spaces between muscle fascicles were also recorded as sites of penetration. The mean muscle thickness in each of these areas was also calculated. RESULTS: In all specimens, the mylohyoid originated not only from the mylohyoid line but also from the lingual surface of the center of the mandibular body (the mandibular symphysis) below the mental spines. The mylohyoid muscle fascicles were thickest in the posterior region, and further anterior to this, they tended to become thinner. Sublingual gland herniations passing through the mylohyoid were noted in the anterior and central regions, but not in the posterior region. Penetration between the muscle fascicles was most common in the central region, and no such penetration was evident in the posterior region. CONCLUSIONS: These results suggest that the mylohyoid functions only incompletely as a septum, and that routes of communication from the sublingual space to the submandibular space may be present in both the anterior and central muscle fascicles of the mylohyoid. Therefore, bleeding complications during dental implant placement in the anterior mandible can be serious issues. There is a potential for sublingual hematoma that could compromise the airway by pressing the tongue against the soft palate into the pharynx.

Ligadura de la arteria lingual: estrategia para hemorragias por lesión de la arteria en la base de la lengua: informe de dos casos / Lingual Artery Ligation: Strategy for Bleeding from Artery Injury at the Base of the Tongue: Report of Two Cases

La hemorragia producida por lesión de la arteria lingual en la base de la lengua por cirugías o por tumores es infrecuente. La mayor frecuencia en la indicación de abordajes transorales para tratar diferentes patologías que afectan la orofaringe requiere que el equipo quirúrgico tenga experiencia en el manejo de esta complicación. La ligadura de la arteria lingual en el cuello es una técnica quirúrgica muy eficaz para solucionar la hemorragia, pero es importante conocer las posibles variantes anatómicas que puede tener la arteria en su trayecto cervical. Debido a su baja incidencia se propone como objetivo describir dos casos clínicos de pacientes que tuvieron hemorragias graves por lesión de la arteria lingual en la base de la lengua, producidas por daño quirúrgico y por erosión por tumor. [AU]

The bleeding caused by injury to the lingual artery at the base of the tongue due to surgery or tumors is infrequent. The increased frequency in the indication of transoral approaches to treat different pathologies affecting the oropharynx requires the surgical team to have experience in managing this complication. Ligation of the lingual artery in the neck is a very effective surgical technique to solve the bleeding; however, it is essential to be aware of the possible anatomical variants the artery may have in its cervical trajectory. Due to its low incidence, we propose to describe two clinical cases of patients who had severe bleeding due to a lesion of the lingual artery at the base of the tongue, produced by surgical damage and erosion due to a tumor. [AU]

A Case of Phlebolith in the Tip of Tongue.

The differential diagnosis of a tongue mass containing calcified bodies includes a phlebolith associated with vascular lesions, such as hemangioma and vascular malformation, and diseases such as neoplasm, osseous choristoma and hypercalcemic states, including hyperparathyroidism. The appearance of the calcified bodies on plain radiographs may help to differentiate these entities. Computed tomography, magnetic resonance imaging, and ultrasonography are also useful for differentiating these soft tissue lesions. We report a 40-year-old man with a small mass containing a calcified body in the tip of tongue. The mass was surgically resected and histologically evaluated, confirming the diagnosis of phlebolith. Our case was a rare phlebolith that did not involve a vascular lesion.

Tongue Mucoceles: a retrospective clinic-pathological evaluation of 240 cases.

BACKGROUND: Minor salivary glands can be found in the ventral and anterior part of the tongue; these glands can rarely develop mucoceles that, due to their rarity and their unusual clinical appearance, may present an interesting differential diagnosis. Mucoceles appear as an exophytic, sometimes pedunculated, lesion, which is a feature that is due to the absence of a capsule; thus, the glands are right beneath the mucosa and over the muscle tissue. The aim of this article is to retrospectively present and discuss the anatomy, pathology, clinical features and therapy of several cases of Blandin-Nunh mucoceles collected from two different institutions. METHODS: A retrospective case review was carried out in two university institutions, retrieving all cases of tongue mucoceles from 1999 to today. Two oral pathologists reviewed all the slides, confirming the diagnosis. Demographic data of the patient, anatomic location and clinical appearance were retrieved from clinical charts, together with the type of surgical procedure and possible relapses. RESULTS: A total of 240 cases of tongue mucoceles were gathered from the archives: the mean age was 22 years (DS = 14,7; Range 2-83), 126 were females (52,5%, mean age 22,7 years, DS = 16,5; Range 2-83), and 114 were males (47,5%, mean age 20,9 years, DS = 12,4; Range 3-73); in all cases, a history of trauma was reported. The ventral surface was the most frequent location (224 cases - 93,3%), and in the great majority (235 cases - 97,9%), pathology revealed mucous spillage with a wall formed by fibrous connective and granulation tissue with no epithelium lining the cavity. Superficial mucocele and sclerosing sialoadenitis were the more frequent pathological variants (21 cases - 8,8%). All lesions were treated with excision and enucleation of the servicing gland. The healing was uneventful in all cases, but there were four recurrences and two cases of sensory paraesthesia of the border of the tongue, all in males, except one case of paraesthesia in a female. CONCLUSIONS: Tongue mucoceles must be differentiated from many benign and malignant lesions. For this reason, surgical removal of the lesion and of the associated gland with a pathological exam is mandatory. In fact, the anatomical location of the glands and the possible pathological variants must be considered to reach a correct diagnosis and diminish possible relapses. TRIAL REGISTRATION: CE-Muc_Ton_3/2023.

Depth of resection predicts loss of tongue tip sensation after partial glossectomy in oral tongue cancer: A pilot study.

OBJECTIVE(S): To characterize the change in sensory function following partial glossectomy for oral tongue cancer (OTC) and to identify predictors of loss of tongue-tip sensation (LoTTS). MATERIALS AND METHODS: Patients with at least three months follow-up after partial glossectomy for primary OTC were included. All patients underwent a qualitative tongue sensation assessment and an objective tongue sensory exam of the native tongue tip. Additional details regarding the oncologic resection, surgical reconstruction, and pathological stage were collected. Multiple linear and logistic regressions were used for statistical analysis. RESULTS: Sixty-four patients were enrolled, including 34 (53%) men with a median age of 65 at enrollment. Ten (15%) patients reported LoTTS. Increased depth of resection (DOR) was an independent predictor of LoTTS on multivariate analysis, with an increased risk at a threshold of 1.3 cm. LoTTS was also associated with worse subjective quality of life and perceptive speech performance in our qualitative tongue assessment. CONCLUSIONS: In this pilot study, we found that DOR is a critical prognostic factor in predicting post treatment function. Patients with an increased DOR, particularly above 1.3 cm, are at greatest risk of LoTTS and associated morbidity. These findings may be used to predict post-operative sensory deficits, manage patients' expectations, and optimize the reconstructive approach. Future studies are needed to validate and replicate our results.

Facilitating the removal of a foreign body in the tongue by intraoperative ultrasound guidance: A case report.

The presence of soft tissue foreign bodies (FBs) presents a substantial concern due to their potential to induce both acute and chronic pain as well as tissue irritation. This case report documents the admission of a 25-year-old female with a history of bur fractures during endodontic treatment, accompanied by signs of infection. The clinical examination and radiographic assessment revealed an embedded foreign body within her tongue. The surgical procedure was informed by repeated ultrasound scans through the incision, facilitating precise targeting. Intraoperative ultrasound enables the accurate detection of submucosal foreign bodies in dynamic tissues like the tongue and facilitates focused and image-guided dissection, thereby decreasing surgical trauma to the delicate soft tissues.

Free Vertical Latissimus Dorsi Flap for Tongue Reconstruction After Total Glossectomy.

BACKGROUND/AIM: The tongue is an important anatomical structure, playing an significant role in natural speech, swallowing, and sense of taste. Immediate reconstruction using autologous tissue must be performed following glossectomy for tongue cancer to improve patient quality of life. This study aimed to demonstrate the usefulness of a surgical technique using the free vertical latissimus dorsi flap (FvLDF) for tongue reconstructions using autologous tissue. PATIENTS AND METHODS: Among patients who underwent total glossectomy for tongue cancer from November 2014 to February 2023, we selected 10 patients who underwent immediate tongue reconstruction with a radial free forearm flap (RFFF) or free anterolateral thigh flap and four patients who underwent FvLDF. The patients were compared regarding postoperative function (width of oropharyngeal space in computed tomography, language-speech evaluation), aesthetic results, and features. RESULTS: All four patients who underwent FvLDF showed successful flap survival, with no severe complications. Because vertical incision was made during flap harvest with primary closure possible with the mid-axillary line, donor morbidity was significantly lower in patients who underwent reconstruction with FvLDF than in those who underwent reconstruction with RFFF, and good aesthetic results were obtained. In comparing the oropharyngeal space of patients on neck CT preoperatively and postoperatively, the width increase rate of patients who underwent reconstruction with FvLDF was significantly smaller. FvLDF patients demonstrated good speech and swallowing functions. CONCLUSION: Considering the advantages of reconstruction with FvLDF in terms of features and aesthetic results, this surgical technique may be a reliable alternative technique for tongue defects after glossectomy.

Functional considerations between flap and non-flap reconstruction in oral tongue cancer: A systematic review.

This systematic review aims to provide insight into the ideal reconstructive approach of the oral tongue in oral tongue cancer (OTC) by investigating the relationship between functional outcomes and the extent of tongue resection. A structured search was performed in Ovid MEDLINE, EMBASE, and Web of Science. Studies comparing patient-reported and objective measurements of the oral tongue function between flap vs. non-flap reconstruction were included. Functional outcomes of interest were speech production, deglutition efficiency, tongue mobility, overall quality of life, and postoperative complications. A total of nine studies were retrieved and critically appraised. Patients with 20 % or less of oral tongue resected had superior swallowing efficiency and speech intelligibility with a non-flap reconstruction while patients with a tongue defect of 40-50 % self-reported or demonstrated better swallowing function with a flap repair. The data in intermediate tongue defects (20-40 % tongue resected) was inconclusive, with several studies reporting comparable functional outcomes between approaches. A longitudinal multi-institutional prospective study that rigidly controls the extent of tongue resected and subsites involved is needed to determine the percentage of tongue resected at which a flap reconstruction yields a superior functional result in OTC.

Clinical application of double V-Y advancement mucosal flap to repair tongue defect. / 双V-Y推进黏膜瓣修复舌部缺损的临床应用.

OBJECTIVES: The repair of small- and medium-sized defects in the oral tongue has always been a challenge, and the effect of free flap and distal pedicle flap is still far from satisfactory. Tongue flap is an ideal choice for repairing small- and medium-sized defects. However, the disadvantages such as poor local morphology restricts the development of this operation.This study aims to investigate the efficacy of double V-Y advancement mucosal flap in repair of small- and medium-sized defects of the tongue defect. METHODS: The clinical data of 15 patients with tongue defect lesions who were hospitalized in the Department of Stomatology, Third Xiangya Hospital of Central South University from March 2019 to May 2022 were retrospectively analyzed. After the lesions were completely excised, the mucosa and part of the tongue defect were left. One V-Y advancement mucosal flap was designed anteriorly and posteriorly to the defect. The superficial mucosa was incised gradually all around, preserving the deep median muscle tip. The 2 flaps were freed toward the middle of the defect, and the anterior and posterior flaps were sutured together at the middle of the defect, with the donor area directly pulled together and sutured. RESULTS: The double V-Y advancement mucosal flap survived in 15 patients, and the wounds healed at stage I. The postoperative follow-up time was 12-22 months, and the patients had no recurrence, with symmetrical tongue shape, and no traction and deformation in the affected tongue organs. Meanwhile, the intraoral flap was thin and flat, and healed well with the surrounding mucosa, without obvious flap contracture or tongue bite. CONCLUSIONS: Double V-Y advancement mucosal flap has the advantages of flexible design, simple preparation, reliable blood supply, and good protection of the donor site, which may be one of the effective methods for repairing small- and medium-sized defects in the anterior tongue mucosa.

Orofacial-Myofunctional therapy after lingual frenectomy in patient with tongue-tie: a systemic postural approach with mezieres method and postural bench.

AIM: In this study we present the new postoperative oro-myofunctional protocol following frenectomy by atmospheric plasma associated with a systemic postural approach, which determines functional recovery through body symmetry restoration based on the concepts of the French "Mezieres Method" and postural bench. METHODS: A total of 130 patients (76 female, 54 male) affected by ankyloglossia of class III/IV, according to Kotlow's Tongue Tie Classification have been treated with atmospheric plasma followed by oro-myofunctional therapy associated with a systemic postural approach. The overall change, improved/worsened speech, feeding, or sleep has been evaluated through the 10 points Parents Speech Satisfaction (PSS) Score after one week and two months. CONCLUSION: Based on the findings of the current investigation, myofunctional therapy in tongue-tie results in a consistent significant functional ameliorating of feeding capability, speech and sleeping of subject treated as reported with traditional oro-myofunctional therapy.

Compartmental tongue surgery for intermediate-advanced squamous cell carcinoma: A multicentric study.

BACKGROUND: A multicentric study was conducted on technical reproducibility of compartmental tongue surgery (CTS) in advanced tongue cancers (OTSCC) and comparison to standard wide margin surgery (SWMS). METHODS: We studied 551 patients with OTSCC treated by CTS and 50 by SWMS. Oncological outcomes were analyzed. A propensity score was performed to compare survival endpoints for the two cohorts. RESULTS: In the CTS group, survival and prognosis were significantly associated with positive lymph-nodes, extranodal extension, depth of invasion and involvement of the soft tissue connecting the tongue primary tumor to neck lymph nodes (T-N tract), independently from the center performing the surgery. SWMS versus CTS showed a HR Cause-Specific Survival (CSS) of 3.24 (95% CI: 1.71-6.11; p < 0.001); HR Loco-Regional Recurrence Free Survival (LRRFS) of 2.54 (95% CI: 1.47-4.40; p < 0.001); HR Overall Survival (OS) of 0.11 (95% CI: 0.01-0.77; p = 0.03). CONCLUSION: Performing the CTS could provide better CSS and LRRFS than SWMS regardless of the center performing the surgery, in advanced OTSSC.