Approach to and reconstruction for lesions of the posterior third of the tongue via midline labiomandibular glossotomy.

Most benign and malignant lesions of the posterior third of the tongue may be approached through a median labiomandibular glossotomy. This is accomplished by splitting the lower lip, mandible, floor of the mouth, and tongue in the midline to expose such areas as the posterior tongue, pharynx, and nasopharynx. This technique is useful for lesions of the posterior third of the tongue for several reasons: 1) it provides excellent exposure, 2) it is cosmetically superior to most other approaches, 3) it allows for several alternatives to reconstruction, such as retrusion or rotation tongue flaps, 4) the procedure sustains minimum blood loss since the tongue is bisected in the midline in an avascular plane, (5) when preoperative radiation therapy has been included, this approach minimizes the amount of surgery performed through the radiated field, and 6) postoperative tongue mobility is usually sufficient to permit articulation and deglutition to approach normal. The Cleveland Clinic Foundation's experience with this approach is reviewed, the technique is described, and a variety of cases are presented to illustrate its applicability.