The First Pull-through Approach to a Tongue Tumor by Giorgio Regnoli in 1838

The aim of this article is to describe the first report of a "pull-through" submental approach for excision of a tongue tumor, performed by Giorgio Regnoli in 1838 on a 14-year-old girl affected by a huge swelling of the tongue, which obstructed the upper airway and hindered swallowing and speech. Regnoli made a midline submental incision, divided the mylohyoid muscle and the oral mucosa, and entered the floor of the mouth. The tongue was pulled into the neck through the newly created opening, and the tumor was circumscribed by thread loops to prevent bleeding and was excised. Then the tongue stump was repositioned in the oral cavity. The skin margins were approximated by bandages. Despite limited armamentarium, the operation was successful. The described approach, subsequently named "pull-through," is still utilized nowadays for selected cases of tongue neoplasms when mandibular splitting is not required.