Isomura Emiko Tanaka, Nakagawa Kiyoko, Mitsui Ryo, Shogen Yosuke, Fujita Takeshi, Kogo Mikihiko
First Department of Oral and Maxillofacial Surgery, Osaka University, Graduate School of Dentistry, Osaka, Japan.
Unit of Dentistry, Osaka University Hospital, Osaka, Japan.
Plast Reconstr Surg Glob Open. 2020 Apr 10;8(4):e2767. doi: 10.1097/GOX.0000000000002767. eCollection 2020 Apr.
When complete recovery of tongue function following tumor excision is desired, reestablishment of the complex movements of the tongue is necessary. However, currently available methods for recovery of tongue function, such as flap surgery or prosthesis insertion, are inadequate. In the current study, we investigated the effects of transplantations of tongue allografts.
Hemi-tongue allotransplantation procedures were performed with 8 pairs of sex-blind and unrelated beagle dogs. In each donor, the right side of the tongue, including the lingual and hypoglossal nerves, extrinsic muscles of the tongue, mucous membrane of the oral floor, lingual artery, and vein were exposed. A vascularized transplantation method was used with manual anastomosis of the blood vessels and nerves.
Survival of the grafted tongue was only noted in 1 dog that died 5 days after transplantation. We suspected that the death was due to nutritional deficiency or dehydration, rather than hyperacute rejection of the transplant or technical failure of the microsurgical anastomosis. The grafted tongue was partially connected to the side of the recipient tongue, and lymphocyte infiltration was observed in this dog.
Postoperative management is difficult in dogs. Even if tongue allograft including nerves and extrinsic muscles is performed, it seems to take a long time before the tongue recovers its functions. Furthermore, expansive tongue allograft was too invasive a treatment for animals. If we want to adapt this procedure to humans, the first trial in a human will be done without animal experiments, as was the case with face transplantations.
当期望肿瘤切除后舌功能完全恢复时，重建舌的复杂运动是必要的。然而，目前可用的恢复舌功能的方法，如皮瓣手术或假体植入，并不充分。在本研究中，我们调查了同种异体舌移植的效果。
对8对性别相同且无亲缘关系的比格犬进行半舌同种异体移植手术。在每个供体中，暴露舌的右侧，包括舌神经和舌下神经、舌的外在肌、口底黏膜、舌动脉和静脉。采用血管化移植方法，手动吻合血管和神经。
仅在1只移植后5天死亡的犬中观察到移植舌存活。我们怀疑死亡是由于营养缺乏或脱水，而非移植的超急性排斥反应或显微外科吻合技术失败。移植舌与受体舌侧部分相连，在这只犬中观察到淋巴细胞浸润。
犬的术后管理困难。即使进行包括神经和外在肌的同种异体舌移植，舌恢复功能似乎也需要很长时间。此外，扩大的同种异体舌移植对动物来说是一种侵入性过大的治疗方法。如果我们想将此手术应用于人类，首次人体试验将像面部移植那样在没有动物实验的情况下进行。
