title: True functional reconstruction of total or subtotal glossectomy defects using a chimeric anterolateral thigh flap with both sensorial and motor innervation.
abstract: BACKGROUND
  The purpose of this study was to report the motor functional outcomes and sensory recovery of patients who had undergone total or subtotal glossectomy for oral squamous cell carcinomas reconstructed with chimeric anterolateral thigh (ALT) flaps.
  
  
  METHODS
  Six patients, 4 men and 2 women, with a mean age of 49.5 years (range, 36-73 years) were included in the study. All patients were treated with chimeric ALT, including the vastus lateralis muscle with its motor nerve and skin paddle with its innervating nerve. All patients were administered functional tests involving sensory recovery, intelligibility, and swallowing. Flap sensibility was evaluated using light touch sensation with the Semmes-Weinstein monofilament test, 2-point discrimination according to the Weber sensitive test, warm and cold temperature sensations, and pain sensation. Intelligibility was scored by a speech therapist on a scale from 1 to 5. Swallowing was assessed by electromyography, deglutition scores (on a scale of 1 to 8), and modified barium swallow. Donor-site morbidities were recorded.
  
  
  RESULTS
  Mean follow-up was 26.6 months (6 months-5 years). The flaps were successful in all 6 patients. The donor site was closed primarily and no complications were seen in the follow-up period. Normal extension of the knee joint and no evidence of lateral patella instability occurred. Speech intelligibility was good (4) in 3 patients and acceptable (3) in 3. Deglutition scores were 6 in 2 patients, 5 in 2, and 4 in 2. Modified barium swallow revealed that 4 patients experienced bolus transit, but 2 required a liquid swallow to promote bolus transit. Electromyographic recordings showed innervations of the vastus lateralis muscle with active generation of motor unit potentials in 4 patients when trying to elevate the tongue. This was not performed in 1 patient, and 1 other had macroscopic muscle contractions. All sensory tests were satisfactory in all parameters.
  
  
  CONCLUSIONS
  The results of this reconstructive option were satisfactory in terms of motor function and sensitive assessment of the neotongue. This technique is strongly recommended for patients with total or subtotal glossectomy.
authors: From the Departments of *Plastic, Reconstructive and Aesthetic Surgery, †Otorhinolaryngology, Akdeniz University School of Medicine, Antalya; and ‡Department of Plastic, Reconstructive and Aesthetic Surgery, Tatvan State Hospital, Bitlis, Turkey.
authors: Ozlenen
authors: O
authors: Ozkan
authors: Omer
authors: O
authors: Ozkan
authors: Alper Tunga
authors: AT
authors: Derin
authors: Gamze
authors: G
authors: Bektas
authors: An
authors: A
authors: Cinpolat
authors: Ahmet
authors: A
authors: Duymaz
authors: Samir
authors: S
authors: Mardini
authors: Emanuele
authors: E
authors: Cigna
authors: Hung-Chi
authors: HC
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D003679:Deglutition; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000294:innervation* / Q000637:transplantation; D005927:Glossectomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D052097:Quadriceps Muscle / Q000294:innervation* / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012677:Sensation; D013060:Speech; D013848:Thigh; D014059:Tongue / Q000294:innervation / Q000502:physiology* / Q000601:surgery; D014062:Tongue Neoplasms / Q000601:surgery*; D016896:Treatment Outcome