The Neurovascular Infrahyoid Muscle Flap: A New Method for Tongue Reconstruction

Abstract

Description of a new neurovascular island flap derived from the infrahyoid muscles to reconstruct a total tongue or large defects of the tongue base. The surgical technique, anatomic findings, and the postoperative function tests with the patients' outcome are described. Eleven patients had tongue cancer, 5 at a T2 stage, 3 at a T3 stage, and 3 at a T4 stage. Four patients underwent total glossectomy, 3 patients underwent hemiglossectomy, and in 2 patients a half and in another 2 patients a quarter of the tongue base were resected. The tongue of the patients who underwent total glossectomy has been reconstructed with the infrahyoid myofascial neurovascular flap from both sides of the neck; in all the other patients this new flap has only been taken from one side of the neck. In one patient a glossectomy had to be combined with a laryngectomy. In 10 patients the tracheostoma could be closed in 4 weeks after the operation, and all patients could eat an oral diet. Electromyography showed voluntary innervation of the reconstructed tongues. With the neurovascular infrahyoid flap, defects of the tongue base can be reconstructed successfully after partial resections or total glossectomies. The main advantage is the voluntary innervation of this flap by means of the ansa cervicalis and the prevention of scarring and atrophy of the reconstructed tongue.

The infrahyoid flap: A comprehensive review of an often overlooked reconstructive method

“…Among the 80 flaps used as myofascial transposition [10,28,29,32], 2 partial muscular necrosis and 3 total were recorded (92.7% success rate).…”

“…7 (informed consent for publication was obtained). Excellent functional results are also obtained for base of tongue reconstructions [10,28], especially if the flap is not detached from the hyoid bone [11].…”

“…Nowadays, this method is reported in 61 published papers, including less than 1400 patients. Only 24 full text papers in the English language were published in 28 years since 1986, with only 10 papers appearing in US Journals [5][6][7][8][9][10][11][12][13][14], the remaining 37 papers were published in other languages (Chinese, French, German, Polish and Japanese).…”

Use of the infra hyoid musculo-cutaneous flap in soft palate reconstruction

“…The main advantage of this voluntary innervated flap is the prevention of atrophies and the improvement of scarring qualities of the reconstructed soft palate. 17 The function qualities are also improved by this innervation conservation which allows synchronous contraction of the two sides of soft palate during swallowing. As Wang et al published, 11 a minor motricity reappears within 12 months after intervention.…”

Infrahyoid flap in oropharyngeal reconstruction following carcinoma resection: A study of 6 patients and literature review

“…Various types of loco-regional and free flaps are used for oropharyngeal reconstruction; but, at present, this issue remains the subject of debate since no 'ideal method' for all situations exists (11,14). The infrahyoid flap (IHF), introduced by Wang et al in 1986 (15), has been demonstrated to be a good alternative to for the reconstruction of small-or medium-sized defects in the oral cavity, oropharynx, hypopharynx and lower third of the face (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). In the present study, a prospective clinical study was performed on a series of consecutive patients with advanced OPSCC, with the aim of defining the principal characteristics and outcomes of oropharyngeal defect reconstruction with a simultaneously harvested IHF.…”