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Optimization of total tongue functional reconstruction with the sushi roll technique and its application in pectoralis major myocutaneous flaps

Published:January 16, 2023DOI:https://doi.org/10.1016/j.ijom.2023.01.002

      Abstract

      A protuberant shape and sufficient volume are the most important parameters for total tongue reconstruction. The conventional pectoralis major myocutaneous (PMMC) flap undergoes collapse due to atrophy of the denervated muscle. In a new technique, this flap was rolled up like sushi to reshape the neotongue. This study explored the feasibility and effect of the ‘sushi roll’ technique for precise total functional reconstruction of the tongue using a PMMC flap. Thirty patients scheduled for total glossectomy and PMMC flap reconstruction were recruited. The sushi roll technique was performed in 15 patients and the conventional repair in 15 patients. Outcomes were compared between the two groups. The flap survived in all 30 patients. The sushi roll group showed superior results to the conventional group in terms of time to oral alimentation (P = 0.012) and decannulation (P = 0.041), as well as swallowing function (P = 0.032), speech intelligibility (P < 0.001), shape (P < 0.001), and quality of life score (P < 0.001) at 12 months. The innovative sushi roll technique uses a folding method that utilizes the length rather than the thickness and width of the flap to maintain the volume and protuberance of the neotongue, which results in acceptable function and improved quality of life.

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      References

        • Ariyan S.
        The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck.
        Plast Reconstr Surg. 1979; 63: 73-81
        • Jing S.S.
        • O’Neill T.
        • Clibbon J.J.
        A comparison between free gracilis muscle flap and pedicled pectoralis major flap reconstructions following salvage laryngectomy.
        J Plast Reconstr Aesthet Surg. 2014; 67: 17-22
        • Mallet Y.
        • El Bedoui S.
        • Penel N.
        • Ton Van J.
        • Fournier C.
        • Lefebvre J.L.
        The free vascularized flap and the pectoralis major pedicled flap options: comparative results of reconstruction of the tongue.
        Oral Oncol. 2009; 45: 1028-1031
        • Rihani J.
        • Lee M.R.
        • Lee T.
        • Ducic Y.
        Flap selection and functional outcomes in total glossectomy with laryngeal preservation.
        Otolaryngol Head Neck Surg. 2013; 149: 547-553
        • Bokhari W.A.
        • Wang S.J.
        Tongue reconstruction: recent advances.
        Curr Opin Otolaryngol Head Neck Surg. 2007; 15: 202-207
        • Fan S.
        • Zhang H.
        • Li Q.
        • Liang F.
        • Bai Z.
        • Chen W.
        • Sun S.
        • Yu P.
        • Li J.
        A novel anatomy-based five-points eight-line-segments technique for precision subtotal tongue reconstruction: a pilot study.
        Oral Oncol. 2019; 89: 1-7
        • Kimata Y.
        • Sakuraba M.
        • Hishinuma S.
        • Ebihara S.
        • Hayashi R.
        • Asakage T.
        • Nakatsuka T.
        • Harii K.
        Analysis of the relations between the shape of the reconstructed tongue and postoperative functions after subtotal or total glossectomy.
        Laryngoscope. 2003; 113: 905-909
        • Hamamoto Y.
        • Nagasao T.
        • Kogure T.
        • Tamai M.
        • Tanaka Y.
        The double-tongue method: a new reconstruction technique for oral floor reconstruction after total glossectomy.
        J Plast Reconstr Aesthet Surg. 2015; 68: 1624-1626
        • Engel H.
        • Huang J.J.
        • Lin C.
        • Lam W.
        • Kao H.
        • Gazyakan E.
        • Cheng M.H.
        A strategic approach for tongue reconstruction to achieve predictable and improved functional and aesthetic outcomes.
        Plast Reconstr Surg. 2010; 126: 1967-1977
        • Sakuraba M.
        • Asano T.
        • Miyamoto S.
        • Hayashi R.
        • Yamazaki M.
        • Miyazaki M.
        • Ugumori T.
        • Daiko H.
        • Kimata Y.
        A new flap design for tongue reconstruction after total or subtotal glossectomy in thin patients.
        J Plast Reconstr Aesthet Surg. 2009; 62: 795-799
        • Mazarro A.
        • de Pablo A.
        • Puiggròs C.
        • Velasco M.M.
        • Saez M.
        • Pamias J.
        • Bescós C.
        Indications, reconstructive techniques, and results for total glossectomy.
        Head Neck. 2016; 38: E2004-E2010
        • Urken M.L.
        • Moscoso J.F.
        • Lawson W.
        • Biller H.F.
        A systematic approach to functional reconstruction of the oral cavity following partial and total glossectomy.
        Arch Otolaryngol Head Neck Surg. 1994; 120: 589-601
        • Zhou X.
        • He Z.J.
        • Su Y.X.
        • Zhang S.
        • Gong Z.J.
        • Wu H.J.
        “Sushi roll” technique for precise total tongue functional reconstruction using a pre-sutured femoral anterolateral myocutaneous flap.
        Oral Oncol. 2020; 110104866
        • Rogers S.N.
        • Ahad S.A.
        • Murphy A.P.
        A structured review and theme analysis of papers published on ‘quality of life’ in head and neck cancer: 2000–2005.
        Oral Oncol. 2007; 43: 843-868
        • Zhou X.
        • Zhang S.E.
        • Nueangkhota P.
        • Liang Y.J.
        • Su Y.X.
        • Liao G.Q.
        Assessment of the contralateral facial artery pedicle nasolabial island flap for buccal defect repair.
        Int J Oral Maxillofac Surg. 2020; 49: 862-866
        • Effron M.Z.
        • Johnson J.T.
        • Myers E.N.
        • Curtin H.
        • Beery Q.
        • Sigler B.
        Advanced carcinoma of the tongue. Management by total glossectomy without laryngectomy.
        Arch Otolaryngol. 1981; 107: 694-697
        • Pradhan S.A.
        • Rajpal R.M.
        Total glossectomy sans laryngectomy—are we justified?.
        Laryngoscope. 1983; 93: 813-815
        • Gangiti K.K.
        • Gondi J.T.
        • Nemade H.
        • Sampathirao L.M.C.S.
        • Raju K.V.V.N.
        • Rao T.S.
        Modified pectoralis major myocutaneous flap for the total glossectomy defects: effect on quality of life.
        J Surg Oncol. 2016; 114: 32-35
        • Nishi Y.
        • Rikimaru H.
        • Kiyokawa K.
        • Watanabe K.
        • Koga N.
        • Sakamoto A.
        Development of the pectoral perforator flap and the deltopectoral perforator flap pedicled with the pectoralis major muscle flap.
        Ann Plast Surg. 2013; 71: 365-371
        • Gil Z.
        • Gupta A.
        • Kummer B.
        • Cordeiro P.G.
        • Kraus D.H.
        • Shah J.P.
        • Patel S.G.
        The role of pectoralis major muscle flap in salvage total laryngectomy.
        Arch Otolaryngol Head Neck Surg. 2009; 135: 1019-1023
        • Quinsan I.
        • Costa G.C.
        • Priante A.
        • Cardoso C.A.
        • Nunes C.
        Functional outcomes and survival of patients with oral and oropharyngeal cancer after total glossectomy.
        Braz J Otorhinolaryngol. 2020; 86: 545-551
        • Son Y.R.
        • Choi K.H.
        • Kim T.G.
        Dysphagia in tongue cancer patients.
        Ann Rehabil Med. 2015; 39: 210-217
        • Matsui Y.
        • Shirota T.
        • Yamashita Y.
        • Ohno K.
        Analyses of speech intelligibility in patients after glossectomy and reconstruction with fasciocutaneous/myocutaneous flaps.
        Int J Oral Maxillofac Surg. 2009; 38: 339-345
        • Longo B.
        • Pagnoni M.
        • Ferri G.
        • Morello R.
        • Santanelli F.
        The mushroom-shaped anterolateral thigh perforator flap for subtotal tongue reconstruction.
        Plast Reconstr Surg. 2013; 132: 656-665
        • Leymarie N.
        • Karsenti G.
        • Sarfati B.
        • Rimareix F.
        • Kolb F.
        Modification of flap design for total mobile tongue reconstruction using a sensitive antero-lateral thigh flap.
        J Plast Reconstr Aesthet Surg. 2012; 65: e169-e174
        • Sharma M.
        • Iyer S.
        • Kuriakose M.A.
        • Vijayaraghavan S.
        • Arun P.
        • Sudhir V.R.
        • Chatni S.S.
        • Sharan R.
        Functional reconstruction of near total glossectomy defects using composite gastro omental-dynamic gracilis flaps.
        J Plast Reconstr Aesthet Surg. 2009; 62: 1277-1280
        • Chuang A.D.
        • Chang C.
        Feasible designs for the anterolateral thigh flap in buccal, glossal, and intra-oral defects.
        J Maxillofac Oral Surg. 2021; https://doi.org/10.1007/s12663-021-01598-x
        • Han S.W.
        • Hong X.W.
        • Li H.
        • Han W.
        Utility of a palatal speech appliance combined with the five-point eight-line segment technique in total tongue reconstruction.
        Int J Oral Maxillofac Surg. 2022; 51: 1016-1021
        • Tarsitano A.
        • Battaglia S.
        • Cipriani R.
        • Marchetti C.
        Microvascular reconstruction of the tongue using a free anterolateral thigh flap: three-dimensional evaluation of volume loss after radiotherapy.
        J Craniomaxillofac Surg. 2016; 44: 1287-1291