Functional Outcomes of Tongue Reconstruction After Cancer Extirpation in Different Flaps: Pedicled Versus Free Flaps: A Systematic Review.

Background: Tongue reconstruction poses significant challenges, involving either pedicle or free flaps, with variations arising from the remnant native tongue tissue or complete neotongue formation. Distinct differences exist between oral tongue and posterior-tongue reconstruction, and the impact of flap nature on functional outcomes remains inconclusive. This study aimed to identify the best flap options for tongue resections based on functional outcomes, help surgeons predict posttreatment quality of life, and explore standardized methods for evaluating swallowing, tongue mobility, speech, and quality of life. Methods: A systematic search of Embase, PubMed, Cochrane Library, and Web of Science identified studies on functional outcomes after tongue reconstruction with flaps. From 782 articles, 42 were included in the review. Four independent researchers assessed bias risk using the Critical Appraisal Skills Program tool. Results: The submental flap was the most common pedicle flap, whereas free flaps such as the anterolateral thigh and radial forearm were frequently used. Functional outcomes were influenced by resection extent, reconstruction type, and postoperative radiotherapy. Neo-tongue reconstruction differed functionally from oral tongue reconstruction. Sensory or motor-innervated flaps showed better swallowing outcomes, but speech results were similar between pedicle and free flaps. Conclusions: The study's findings are limited by inconsistent data, retrospective designs, and lack of standardized methods, necessitating cautious interpretation. Free flaps consistently offer better functional outcomes for tongue reconstruction, improving over time with rehabilitation. Free flaps tailored to defect size are preferred over pedicle flaps for superior results, regardless of reconstruction site.