Characterization of Change in Tongue Volume Post-Hemiglossectomy with Variable Autologous Free Flap Reconstruction

Tuesday, October 14, 2025

10:06 AM - 10:12 AM EDT

Location: 128

Disclosure(s):

Audrey M. Abend, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Following glossectomy, tongue reconstruction via autologous free flap can reapproximate native form and function, significantly improving postoperative quality of life. Various studies have examined functional outcomes between commonly employed radial forearm free flap (RFFF) and the anterolateral thigh free flap (ALTFF); however, the changes in neotongue volumetric bulk over time is less clearly understood. We aimed to assess postoperative outcomes and volume changes in patients undergoing glossectomy with immediate reconstruction.

Methods: Patients who underwent hemiglossectomy with RFFF or ALTFF reconstruction between May 2009 and June 2024 were retrospectively identified. Patients with total glossectomy, prior or staged flap reconstruction, or unavailable imaging were excluded. Patient demographic, past medical history, and treatment course were collected. Perioperative imaging was utilized to measure native tongue, tumor, and postoperative neotongue volumes.

Results: Of 35 patients identified, ALTFF patients presented with greater tumor stage and depth of invasion than RFFF patients. Volumetric analysis of 17 patients revealed a mean tongue size decrease of 31.68cm3 (SD, 42.02). Correlational analyses revealed a significant negative relationship of tongue volume over time (Spearman coefficient=-0.52, p=0.04). No significant relationship was found between flap type or mass volume and change in total tongue size (F=1.25, p=0.28, F=1.50, p=0.24, respectively). Length of time was associated with total change in tongue bulk, independent of flap type or mass volume (F=4.85, p=0.046). ALTFF patients trended towards a greater rate of PEG tube dependence than RFFF patients at 1 month, but by 3 months all patients tolerated oral intake.

Conclusions: Postoperative neotongue volume decreased in both the ALT and RFFF flap cohorts over time but was not impacted by flap type or mass size. There was no significant difference in functional outcomes between flap types. Further research is warranted to understand the impact of flap design on neotongue atrophy.

Presenting Author(s)

Audrey M. Abend, MD

PGY1, Duke OHNS
Duke Department of Head and Neck Surgery
Durham, NC, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Audrey M. Abend, MD

PGY1, Duke OHNS
Duke Department of Head and Neck Surgery
Durham, NC, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
SS

Sophia Salingaros, Other

MS4 Medical Student
Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, United States

Disclosure information not submitted.
Adrienne E. Biskaduros, Other

MS3 Medical Student
Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine
New York, NY, United States

Disclosure information not submitted.
MS

Matthew Spano, MD

Neuroradiology Fellow
Department of Radiology, Weill Cornell Medicine, United States

Disclosure information not submitted.
MW

Matthew Wright, MD

PGY-5 Resident
Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, United States

Disclosure information not submitted.
SS

Sara Strauss, MD

Assistant Professor of Radiology
Department of Radiology, Weill Cornell Medicine, United States

Disclosure information not submitted.
JS

Jason Spector, MD

Chief, Division of Plastic and Reconstructive Surgery, Professor of Surgery and Otolaryngology
Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, United States

Disclosure information not submitted.
DK

David Kutler, MD

Weill Cornell Medicine Otolaryngology Head and Neck Surgery, United States

Disclosure information not submitted.

Senior Author(s)

DK

David Kutler, MD

Weill Cornell Medicine Otolaryngology Head and Neck Surgery, United States

Disclosure information not submitted.