Abstract
The postoperative swallowing function was investigated in 18 patients who underwent reconstruction of the base of the tongue and/or lateral pharyngeal wall with free tissue transfer. It was evaluted on the basis of type of food, the water swallowing test, and video fluorography. The extent of the tongue resection included more than half of the oral tongue and the base of the tongue, the suprahyoid muscles, and the floor of the mouth on the same side. Resection of the lateral pharyngeal wall was combined with resection of the tongue or mandibulectomy of the ramus. In 10 patients who underwent hemiglossectomy alone or hemiglossectomy combined with resection of the lateral pharyngeal wall, reconstruction was done using an anterolateral thigh flap (ALT) or a rectos abdominis flap (RAB). Recovery of an excellent swallowing function was achieved. Among three patients with subtotal glossectomy and resection of the lateral pharyngeal wall who underwent reconstruction with a large ALT, two were unable to eat orally because of consistent severe aspiration. The other ate mixed food with occasional aspiration. Among five patients with a surgical defect of the lateral pharyngeal wall combined with mandibulectomy of the ramus, two patients who underwent reconstruction with a radial forearm flap or an ALT postoperatively showed a better swallowing function than the remaining three patients who underwent primary closure of the residual lateral pharyngeal wall. The swallowing function following tongue reconstruction with an ALT or an RAB decreased as the extent of the tongue base resected increased. Dysfunction of oropharyngeal closure because of the decreased volume of the reconstructed tongue base and the difficulty of laryngeal elevation with wide resection of the suprahyoid muscles were suspected as causes for dysphasia. It is necessary to improve the reconstruction method to increase the volume of the base of the tongue and to perform laryngeal suspension and cricopharyngeal myotomy to prevent aspiration for cases of subtotal glossectomy with wide resection of the suprahyoid muscles.
