Intraoral R Econstruction With Tongue Musculomucosal Flaps
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A good study of the vascular anatomy of the tongue and its relevance in the design of tongue flaps can be found in Bracka, A. The blood supply of dorsal tongue flaps. Br J Plast Surg 34;379, 1981.
The tongue musculomucosal flap provides the most dependable means of reconstructing the lining of the oral cavity. The tongue flap is especially useful in the surgical correction of palatal perforations that are large or surrounded by thickened fibrous tissue. Using tongue flaps, a surgeon can be more aggressive in removing tumors and still give the patient the opportunity for successful rehabilitation through immediate reconstruction.
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.
Floor of the Mouth and Tonsillar Area Reconstruction
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).
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