Use of the tongue flap for intraoral reconstruction: A report of 16 cases

Abstract

Kim et al’s article covers a variety of “pedicle-to-paddle” flap designs individualized to given surgical defects and, as such, it again underscores the versatility of these local flaps. However, there are some additional comments, general thoughts, and questions that should be considered when the surgeon is contemplating using a lingual flap. First, it must be remembered that the lingual flap is not infallible, as seen in Table 2. Moreover, tongue flaps seem to do better in older patients. All subjects were in the current study adults. In my experience, the limited attention span of a child or that of a less committed and emotionally immature adult adversely affects patient compliance. Too often the flaps are “tugged on” in the “normal activities” of deglutition and speech. Fixation schemes such as transfixing the lingual base with K-wires or maxillomandibular fixation may help, but not always.’ Anteriorly based dorsal flaps are better for anterior maxillary defects; lateral flaps are more applicable to abnormal lateral maxillary defects. Defects of the anterior mandible and some of the maxilla may be better covered with other local or regional flaps, for example, nasolabial, temporal, or temporoparietal designs. Additionally, the vascular&y of any tongue flap, however abundant, cannot be routinely relied on to induce reciprocal vascularization from a scarred (or irradiated) recipient bed. Thus, on division of the bridge, the paddle is subjected to vascular compromise. Preparatory treatment, such as the use of hyperbaric oxygen, may help. Relative to speech, for the English language at least,