Functional Reconstruction of the Tongue Using the Latissimus Dorsi and Serratus Anterior Chimeric Flap with Motor Innervation

Objectives: The purpose of this study is to repor evaluate the outcomes of functional rehabilitation of patients who had undergone total or subtotal glossectomy with mouth flor muscles and suprahyoid muscles resection for oral carcinomas, reconstructed with the latissimus dorsi and serratus anterior (LD+SA) chimeric flap with motor innervation.

Materials and methods: In the study 5 patients with primary locally advanced tongue cancer and 6 with recurrent cancer from 2016 to 2018 years were included. The operation plan included total or subtotal glossectomy with mouth flor muscles and suprahyoid muscles resection radical lymphadenectomy on both sides. All patients were treated with LD+SA chimeric flap, including a myocutaneous portion, from the partial of the latissimus muscle and muscle portion of the anterior serratus muscle, on a single vascular pedicle. In these flap included thoracodorsal and long thoracic nerves The myocutaneous part of the chimeric flap of latissimus dorsi muscles was fixed between the mandible and the base epiglottis to reconstruct the tongue. Mouth flor muscles and suprahyoid muscles replacement was achieved by a muscle flap`s portion of serratus anterior. In all cases flap was re innervated with hypoglossal nerve.

Results: Mean follow-up was 14,5 months. In all cases was not flap necrosis. The donor site was closed primarily, and no complications were seen in the follow-up period. In the end of the second month self-swallowing was without aspiration in 8 patients. Seven patients underwent decannulation on mean interval 2,5 month. Speech was restored after 3 month after operation. Speech intelligibility was good in 5 patients and acceptable in 6.

Conclusion: Our approach provides radical tumor resection with mouth floor reconstruction and with neo-tongue creation. Satisfactory results were obtained in 70 percent of the patients in this study. This reconstruction method is offering them a major improvement in their quality of life.