Classification of tongue cancer resection and treatment algorithm

Abstract

Background and objectives: Reconstruction of tongue cancer defects is challenging due to the complex anatomy and physiology of the tongue. Here, we classify patterns of tongue tissue loss and describe a treatment algorithm for achieving good functional and oncologic outcomes.

Methods: We retrospectively reviewed 50 tongue squamous-cell carcinomas surgically treated between January 2010-June 2015. Cancer resection and tongue reconstruction were stratified according to the missing anatomical subunits.

Results: A type 1 defect is a unilateral and marginal defect, not crossing the midline, and not extending to the posterior-third of the tongue. Type 2 involves the two-anterior-thirds of the mobile body, not crossing the midline, without posterior-third evolvement. Type 3 involves the two-anterior-thirds of the mobile body of the tongue with contralateral extension. Type 4 extends to the tongue base. Type 5 defect comprises any of the previous defects along with involvement of the floor of the mouth. Type 2 and 3 defects were the most common. Microvascular reconstruction was performed in 23 out of 50 patients. Complications included infection, partial necrosis, dehiscence, and microvascular thrombosis.

Conclusions: Our classification system and treatment algorithm represent a reliable method of addressing management of tongue defects.

Keywords: functional and aesthetic outcomes; reconstructive options; tongue cancer; tongue defect classification; tongue reconstruction algorithm.