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

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

44. Dorsoventral flap

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

46. Ventral based flaps

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