Tongue Cancer Resection & Microvascular Reconstruction.

Depth of Invasion (DOI) is a microscopic pathological measurement of how deeply the tumor has penetrated beneath the mucosal surface lining of the tongue. It differs from physical tumor thickness. Under the AJCC 8th edition staging system, a DOI of greater than 5mm is a major threshold. Cancers with DOI > 5mm have a highly elevated risk of spreading (micro-metastasis) to the lymph nodes in the neck. Even if preoperative neck CT/MRI scans show no signs of nodes (cN0), a neck dissection is standard clinical protocol for tumors with DOI > 5mm to clear out potential microscopic cancer deposits.

Yes, significant functional recovery is achievable through immediate microvascular free flap reconstruction and postoperative speech therapy. If a substantial portion of the tongue is removed, replacing it with a radial forearm flap (thin, mobile) or an anterolateral thigh flap (thick, bulk-restoring) restores oral volume. This allows the remaining mobile tongue tissue to make contact with the palate, preserving speech clarity and swallowing coordination. Full rehabilitation takes several months, supported by dedicated oral exercises.

A neck dissection is necessary in two scenarios: 1. Therapeutic Neck Dissection: When preoperative imaging (CT, MRI, or PET) or clinical palpation indicates that cancer has spread to the cervical lymph nodes. 2. Elective Neck Dissection (END): When the neck is clinically normal (cN0) but the primary tongue tumor is invasive (DOI > 4-5mm). Because the sublingual lymphatic channels drain directly into the neck, the statistical risk of hidden (occult) microscopic metastasis is over 20%, making elective clearance the safest surgical choice to prevent future recurrence.

No. It is a medical myth that performing a biopsy causes tongue cancer to spread or metastasize. A biopsy is an essential, diagnostic step. Without it, the medical team cannot confirm squamous cell carcinoma, establish grading, or legally initiate surgery or oncological therapies. Delaying a biopsy due to fear of tumor spread allows the cancer to grow deeper (increasing DOI) and actually increases the risk of lymph node metastasis.