Total Glossectomy + Reconstruction with
Gastro-omental Microvascular Flap
Total Glossectomy + Reconstruction with Gastro-omental Microvascular Flap
Fig.1 Incision was made in floor of mouth. Rim resection of mandible was done on left side (green arrow).Using ‘pull-through’ technique, tongue is pulled into the neck. Total glossectomy, rim resection of mandible andepiglottectomy was done.
Fig.2 After total glossectomy, rim resection of mandible & bilateral neck dissection. White arrow – hyoid bone.
Fig.3 Resected specimen of total glossectomy & rim resection (white arrow).
Fig.4 Greater curvature of stomach and omentum were removed along with right gastroepiploic artery for reconstructing the tongue.
Fig.5 Larynx is pulled up and suspended from mandible (green arrows).This tucks the larynx under the neotongue to prevent aspiration. White interrupted line – hyoid bone.
Fig.6 Stomach wall is sutured to the mucosal edges in oral cavity and oropharynx (white arrow). Yellow arrow – omentum.
Fig.7 Omentum is tucked under the stomach wall and that gives a convex surface for the neotongue.
Fig.8 While swallowing, larynx moves up and gets tucked under the tongue base. This doesn’t happen after total glossectomy and results in aspiration. To prevent aspiration, anterior static laryngeal suspension is done.
Fig.9 Larynx is pulled up and suspended from mandible (green arrows).This tucks the larynx under the neotongue to prevent aspiration. White interrupted line – hyoid bone.
Fig.10 Post-op. Normal looking neotongue. Mucous secretion of the stomach wall solves the problem of dryness after radiotherapy.
Patient is drinking water 10 days after surgery without aspiration
The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)
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The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)