title: Flap selection and functional outcomes in total glossectomy with laryngeal preservation.
abstract: OBJECTIVE
  Reconstruction of total glossectomy defects has been revolutionized by the popularity of free flap use in the head and neck. Challenging defects can be addressed with a variety of different free and pedicled flaps. The purpose of this study is to review our method of flap selection in cases of total glossectomy defects with laryngeal preservation, with an emphasis on the variations of these defects and patient body habitus.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care referral center.
  
  
  METHODS
  All patients undergoing total glossectomy with laryngeal preservation (TGLP) by the senior author (YD) from September 1997 to May 2012. Objective data regarding patient demographics, existing defect, method of reconstruction, adjuvant treatment, operative details, outcomes, and complications were recorded. Both means and frequency of prolonged tracheostomy or gastrostomy tube were used to assess outcomes.
  
  
  RESULTS
  One hundred and three patients were identified. Ninety-four met inclusion criteria. All patients were T3 or T4 stage tumors. Mean follow-up was 3.4 years. Fifty-nine patients (62%) underwent free flap reconstruction while the remaining 35 (37%) were treated with a pedicled pectoralis myocutaneous flap. Tracheostomy decannulation and gastrostomy tube removal rates were 84% and 29%, respectively. No patients were converted to total laryngectomy.
  
  
  CONCLUSIONS
  Optimal reconstruction of TGLP defects may be accomplished with either pedicled or free-tissue flap reconstruction. Selecting an ideal flap for reconstruction of total glossectomy defects should be patient specific and based on matching donor flap bulk. This treatment approach demonstrates high tracheostomy and gastric tube independence.
authors.affiliation: Departments of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Rihani
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lee
authors.forename: Thomas
authors.initials: T
authors.lastname: Lee
authors.forename: Yadranko
authors.initials: Y
authors.lastname: Ducic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D005927:Glossectomy / Q000379:methods; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D020127:Recovery of Function; D000077195:Squamous Cell Carcinoma of Head and Neck; D013524:Surgical Flaps; D014062:Tongue Neoplasms / Q000601:surgery*; D014139:Tracheostomy; D016896:Treatment Outcome
keywords: free flap reconstruction; laryngeal preservation; oral cavity defect; oral cavity reconstruction; pectoralis muscle flap; tongue cancer; tongue defect; total glossectomy