29/10/2025
SUCCESSFUL RESECTION OF TONGUE CARCINOMA WITH RECONSTRUCTION OF TONGUE AND FLOOR OF MOUTH USING ANTEROLATERAL THIGH FLAP
This 34-year-old male had initially presented with an ulcer and swelling of the right tongue along with chewing and breathing difficulties. He was subsequently referred to Balaji Dental and Craniofacial Hospital with a biopsy proven, well-differentiated squamous cell carcinoma of the right tongue extending to the left. He underwent comprehensive laboratory and imaging studies including MRI and whole body PET-CT scan.
Tumour board recommendation was for the patient to undergo tracheostomy and PEG tube insertion to help with feeding and breathing after surgery followed by total glossectomy, right modified radical neck dissection and left selective neck dissection with removal of lymph nodes and marginal mandibulectomy followed by reconstruction with an anterolateral thigh flap harvested from the patient himself. The surgical team led by Dr. SM Balaji, senior oral cancer and craniomaxillofacial surgeon, meticulously planned the surgery.
Surgery commenced with identification of the marginal mandibular nerve, which was preserved. The facial artery and the facial vein were then identified, ligated and cut as were the bilateral lingual arteries and the hypoglossal nerve. Care was also taken to identify and preserve the internal jugular vein.
The right modified radical neck dissection and left selective neck dissection with removal of lymph nodes was then performed. This was followed by marginal mandibulectomy and resection of the tongue cancer and mandibular segment. Frozen sections sent for histopathological examination returned with negative margins.
Reconstruction of the tongue and floor of mouth was performed using an anterolateral thigh flap, which was harvested from the patient. The descending branch of the lateral circumflex femoral artery was carefully anastomosed to the facial artery and venae comitantes anastomosed to the common facial vein. Good blood supply to the flap was demonstrated using the pinprick test following anastomosis of the blood vessels.
There were excellent results following the surgery. The patient would need to undergo further surgery for mandibular reconstruction to complete his rehabilitation.