The tongue flap is particularly useful in heavily irradiated patients by providing additional muscle coverage of the bones. It plays an important role in the treatment of large fistulas (1, 2, 3, 4, 5, 6, 7, 8, 9). The closure of perforations in the soft palate is preferably done with the use of the palatal tissues themselves, and in extensive perforations, we can use a combined reconstructive method that uses a tongue flap and a pharyngeal flap.

In the buccal area, tissue losses that include the mucosa alone or some or all of the anatomic layers can be reconstructed with a tongue flap (10, 11). The flap can be designed to vary the amount of muscle that is considered necessary for reconstructing the defect (see Fig. 185.5). For full-thickness cheek losses, the tongue musculomucosal flap can be used for the inner lining, and the outer covering can be provided by either a forehead flap or a large pectoralis major musculocutaneous flap.

The tongue flap can be used for reconstructing either a primary or a secondary defect in both the floor of the mouth (12, 13, 14, 15) and the tonsillar area (16, 17).