Surgical Management of Oral Squamous Cell Carcinoma With Reconstruction of the Oral Defect Using a Lingual Island Flap: Case Report.

Oral squamous cell carcinoma (OSCC) is the most common malignant neoplasm of the oral cavity and requires surgical resection with adequate oncologic margins and functional reconstruction of the resulting defect. We report the case of a 78-year-old male patient with locally recurrent well-differentiated OSCC who was treated with surgical resection with 10 mm safety margins, reconstruction with an island tongue flap, and selective bilateral Level IA neck dissection. Although microvascular free flaps represent the reconstructive gold standard for extensive defects and the submental flap is a reliable regional alternative, the island tongue flap was selected because of the posterior location of the defect, the moderate size of the resection, and the availability of adjacent tissue with similar characteristics, allowing adequate intraoral coverage with lower surgical morbidity. One of its main disadvantages is the need for a second procedure to divide the pedicle. Postoperative follow-up demonstrated satisfactory intraoral healing, with no evidence of flap necrosis, wound dehiscence, or scar contracture. Adequate tongue mobility, including protrusion, elevation, and lateralization, was observed, with satisfactory preservation of speech, swallowing, and mouth opening. At the 14 months of follow-up, the patient remained asymptomatic, with preserved oral function and no clinical evidence of local recurrence. This case demonstrates that the island tongue flap remains an effective and functional reconstructive option for selected posterior intraoral defects, providing favorable medium-term outcomes, preservation of oral function, and minimal morbidity.