Clinical Efficacy of Neurorrhaphy in Anterolateral Thigh Flap Reconstruction for Tongue Cancer Defects: A Randomized Controlled Trial.

BACKGROUND: Oral cancer, particularly tongue cancer, can lead to significant functional impairments, including loss of sensation and speech and swallowing difficulties. The anterolateral thigh (ALT) flap is typically used for reconstructing tongue defects, but restoring sensory and motor functions remains challenging. Nerve anastomosis has been proposed to enhance functional recovery. METHODS: This randomized controlled trial included 40 patients who underwent hemiglossectomy and reconstruction with ALT flaps. Patients were assigned to two groups: the ALT group (n = 19), with no nerve anastomosis, and the neural anterolateral thigh flap (N-ALT) group (n = 21), with simultaneous nerve anastomosis. Functional outcomes, including sensory, speech, and swallowing assessments, were evaluated at 2, 6, and 12 months postsurgery. Quality of life (QoL) was also assessed using the University of Washington Quality of Life (UW-QoL) questionnaire. RESULTS: Compared with the ALT group, the N-ALT group showed significantly better sensory recovery, including two-point discrimination and touch pressure sensation (p < 0.05). Speech and swallowing functions were also superior in the N-ALT group at 2, 6, and 12 months after surgery. Additionally, patients in the N-ALT group had better QoL, especially in the emotional and swallowing domains. Flap volume analysis revealed less atrophy in the N-ALT group. CONCLUSIONS: Nerve anastomosis during ALT flap reconstruction for tongue cancer significantly improves sensory, speech, and swallowing functions, contributing to better postoperative quality of life. These findings support the use of nerve anastomosis as an effective strategy for enhancing functional recovery in tongue cancer reconstruction. Further long-term studies are needed to validate these benefits.