A Systematic Review and Meta-Analysis of Functional Tongue Reconstruction Using Dynamic Free Flap Designs.

Abstract

The treatment of tongue malignancies frequently produces deficits in feeding, swallowing, and speech intelligibility. These have a significant impact on patients' quality-of-life. Free tissue transfer is the preferred method for reconstructing larger, complex defects, and aims to restore both mechanical and sensory function while protecting the airway. The role of dynamic free flap designs incorporating motor reinnervation remains unclear, particularly in cases with more extensive glossectomy defects. The objective of this systematic review is to evaluate the speech and swallow outcomes of patients undergoing dynamic free flap reconstruction following ablative tongue surgery. A systematic review was performed to determine the role of dynamic free flap surgery for functional tongue reconstruction. Searches were conducted in MEDLINE (PubMed), EMBASE, the Cochrane Library, Google Scholar, and included English-language studies from 1980 onward. Search terms included: glossectomy in combination with functional reconstruction and related outcomes. Primary outcome measures were flap compromise, competent swallow, and intelligible speech. A meta-analysis was performed using pooled data from comparative studies. Key data analysis was undertaken to calculate weighted effect sizes using random-effects models. Thirteen studies reported on the use of dynamic free flaps for tongue reconstruction. A total of 168 innervated flaps were available for comparison after pooling data. The non-weighted flap failure rate was 1.2% within this cohort. Competent swallow varied from 43% to 100% with a mean value of 80.2%. Rates of satisfactory speech were between 73% and 100% with a mean value of 91.7%. The mean follow-up duration was 21.8 months and ranged between 9.5 and 47.6 months. With further analyses of comparative sub-groups, there was a marked improvement in swallow competency with dynamic flap types over static designs (OR = 4.09, 95% CI: 1.75, 9.58, p = < 0.01). Current evidence indicates that dynamic free flap designs enhance functional recovery and may benefit both swallow and speech outcomes postoperatively.