Advanced Tongue Cancer: Bharat Bhushan ji's Experience of Surgery: To Reconstruct Tongue or Not

In this episode, we sit down with Mr. Bharat Bhushan and his daughter Manisha to reflect on his recent journey through tongue cancer surgery and reconstruction. Manisha, though an MCA professional, came remarkably well-prepared with a thoughtful question that most attendants rarely ask: “Why do we reconstruct the tongue at all?” Unlike cosmetic concerns, the tongue is not a visible structure. Its reconstruction, as she insightfully pointed out, often results in an insensate flap—adding bulk but not sensation. The true value of reconstruction, therefore, lies not in appearance, but in preserving mobility—the essential function that allows the tongue to speak, swallow, sweep the mouth, and maintain oral hygiene. Together, we explore: • Oncological principles: the necessity of wide local excision for cure. • Pre-operative imaging: the role of MRI in assessing depth, margins, and tumor extent; the contribution of PET for nodal status. • Reconstructive choices: from secondary healing to primary closure, radial forearm and ALT flaps. • The guiding principle: reconstruction only when it permits mobility, never for cosmesis. • Our center’s experience: more than 50 successful microvascular reconstructions with Dr. Akhil, with no flap losses—achieving functional outcomes beyond international averages. • Mr. Bhushan’s case: Initially attempted with primary closure, but when tongue mobility was compromised, an ALT free flap was used. At 15 days post-op, he is swallowing, speaking, and fully healed. Final histopathology showed PNI positive and DOI 15 mm, with negative nodes—guiding the decision for adjuvant radiation therapy. This candid discussion offers both the patient’s perspective and the surgical team’s philosophy—shedding light on the delicate balance between oncological clearance and functional preservation. #TongueCancer #HeadAndNeckOncology #MicrovascularSurgery #ALTFlap #OncologyPodcast #CancerAwareness #ReconstructionDebate