Mobility-based Intraoperative Decision-making in Reconstruction after Lateral Oral Tongue Resection: A Prospective Case Series

Abstract

Background: Oral tongue squamous cell carcinoma (OTSCC) demands a reconstructive approach that prioritises functional recovery over geometric defect restoration. Traditional algorithms based on percentage of tongue resected or defect size may inadequately account for the single most important functional predictor: residual tongue mobility. This case series prospectively documents a mobility-first reconstructive philosophy applied over three consecutive years. Methods: Twenty-nine consecutive patients undergoing lateral oral tongue resection for OTSCC at a single tertiary oncology unit were included. All were assessed intraoperatively for residual tongue mobility following resection. The choice between primary longitudinal closure and microvascular free flap reconstruction was determined by a defined, reproducible, on-table mobility test. All patients provided written informed consent. No validated scoring instruments were applied; the primary functional endpoint was clinical assessment of the three core domains — speech intelligibility, swallowing progression, and oral clearance — collectively termed the "3S" framework. Results: Eleven patients (37.9%) achieved satisfactory 3S outcomes with primary longitudinal closure alone. Eighteen patients (62.1%) required microvascular reconstruction on account of floor-of-mouth resection (planned or margin-driven) or intraoperative tethering on trial closure. Of the reconstructed cohort, three patients received a radial forearm free flap (RFFF) and fifteen a thin anterolateral thigh (ALT) free flap. Flap survival was 100%. Two ALT donor sites developed superficial wound infections managed conservatively. No major donor-site morbidity was recorded. Functional recovery of 3S domains was achieved in all patients before discharge from the surgical unit. Conclusion: This prospective case series suggests that a mobility-based intraoperative assessment may be a useful aid in reconstructive decision-making after lateral tongue resection. Primary closure was feasible in selected patients with preserved tongue mobility, while thin ALT free flap reconstruction provided acceptable early functional outcomes in patients with floor-of-mouth tethering or restricted mobility. These findings are clinically encouraging but should be interpreted cautiously given the small sample size, single-centre design, non-validated outcome assessment, and limited follow-up.