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Dr Junaid Khurshid on Tongue Flaps 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
- 32. History • Tongue flaps introduced by lexer in 1909 • Properrties • Relaible • Easily obtanable • Excellent vascularity • Large ammount of tissue • Usually for large defects
- 33. Intra oral flaps • Tongue flap • Buccal flap • Palatal flap
- 34. 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
- 36. Posterior based dorsal flaps
- 37. 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
- 38. Anterior based dorsal flap
- 39. • 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
- 40. Transverse dorsal tongue flap
- 41. • 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
- 42. Perimeter flap
- 43. • 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
- 45. • 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
- 47. • 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
- 48. Sliding Anterior Hemitongue Flap for Posterior Tongue Defect Reconstruction
- 49. • 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
- 50. Case 1 • Anteriorly Based Tongue Flap for Closure of a Posterior Palatal Defect in a Patient with Exaggerated Gag Reflex
- 51. 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.
- 52. Anteriorly based tongue flap raised showing muscle thickness utilized
- 53. Flap base inset into donor site.
- 54. 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.
- 55. Asessment • Flap viability • Fistula closure • Residual tongue function • Asthetics • Asessment of speech impediment
- 56. Speech assessment • Articulation • Speech intelligibility • Nasal emission • Hypernasality • Findings documented by speech pathologist
- 57. case 2 • A laterally based posterior tongue flap being utilized for left maxillary oral-antral communication closure
- 59. Case 3 A dorsal anteriorly based tongue flap being used for left maxillary oral-antral communication
- 61. Case 4 • Anterior based dorsal flap for anterior palatal fistula
- 63. 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 • Extremely successful with minimal morbidity.
- 64. Thank you