Reconstruction of tongue cancer defects is challenging as the surgeon must consider the adequate control of the malignancy, while also optimizing the remaining functional capacity. With improvements in the locoregional control and survival rate due to advances in multimodality treatment, the functional outcomes are to be considered as equally important factors as they determine the patients’ quality of life.(Zhang et al., 2018; Ferri et al., 2020) Depending on the location and extent of the tongue defect, the functional deficits manifest as varied entities involving oral competence, speech, and swallowing function.(Kansy et al., 2017) The tongue has multiple diverse functions due to its anatomic components, which comprise eight paired muscles, and it is difficult to restore the complex biomechanics and anatomic relationships of the neotongue with the remaining structures.(Ren et al., 2015)

The fasciocutaneous free flap has been the traditional option for tongue reconstruction owing to its high versatility in flap design, coverage of the defect, and tolerability for adjuvant treatment. However, as the tongue is a mobile unit, the reconstruction with fasciocutaneous free flaps always results in a change to a static unit. As a result of this, motor-innervated free flaps have been adopted as a dynamic way to mimic the original tongue muscle.(Yamamoto et al., 1998; Sharma et al., 2009; Calabrese et al., 2011; Ozkan et al., 2015; Pellini et al., 2016; Righini et al., 2019; Park et al., 2021) Various attempts have been made in the literature, using innervated musculocutaneous free flaps, such as the rectus abdominis and the gracilis muscles.(Yamamoto et al., 1998) The transferred muscle seems to increase the volume, thereby allowing close contact between the tongue and remaining structures.(Calabrese et al., 2011; Righini et al., 2019) More complex types of free flaps, such as those with a composite or chimeric pattern, reportedly provide an individual subunit containing mobile and static structures.(Sharma et al., 2009; Ozkan et al., 2015)

Nevertheless, there is no consensus on the best functional reconstruction technique for the various types of glossectomy defects. Previous studies have had several limitations, such as small cohorts, an absence of comparison with the traditional method, and heterogeneity in the study subjects due to various different defects.(Yamamoto et al., 1998; Sharma et al., 2009; Calabrese et al., 2011; Ozkan et al., 2015; Pellini et al., 2016; Righini et al., 2019; Park et al., 2021) To determine the efficacy of a dynamic technique using motor nerve coaptation in the field of tongue reconstruction, we retrospectively reviewed the functional outcomes in patients with various types of glossectomy defects. This study aimed to compare the functional outcomes including speech, tongue mobility, and swallowing in patients who underwent either dynamic or conventional reconstruction following cancer ablation with various extents of glossectomy.