口腔悪性腫瘍切除後の外科的再建による顎口腔機能回復に関する研究

舌口底・口底下顎切除症例の術後会話能力について

抄録

The present study was one of a series of studies on recovery of oral and maxillofacial function by surgical reconstruction after malignant tumor ablation. The objective of this study was to identify the relations among postoperative conversational ability, resection range, and reconstruction method.
The subjects were 74 patients with oral cancer who underwent resection involving the tongue, mouth floor, and mandible. They were classified into Group I (mandibulectomy without glossectomy, n=24), Group II (partial glossectomy, n=8), Group III (hemiglossectomy, n=28), and Group N (subtotal glossectomy, n=14) according to the resection pattern of the tongue. They were then subdivided according to the combined resection range of the tongue, mouth floor, and mandible. The conversational intelligibility (CI) of each patient was rated on a scale from 1 to 5, and the relation between the CI and the resection pattern of the tongue, the combined resection range of the tongue, mouth floor, and mandible, the reconstruction method, and the shape and mobility of the reconstructed tongue was analyzed.
The following conclusions were obtained:(1) CI significantly decreased in the order of Groups I and II, III, and N.(2) The CI of all patients in Group I and II was well intelligible (CI score 1) regardless of the resection range and reconstructed method, with little deterioration of daily speech.(3) In Groups III and IV, the CI significantly decreased with an increase in the combined resection range of the tongue, mouth floor, and mandible. In the patients who underwent hemiglossectomy, limiting the mobile tongue, combined with mandibulectomy, articulation ability negatively correlated with the resection range of the mandible from the molar region of the affected side to the anterior tooth region. The CI of almost all patients who underwent hemiglossectomy including the root of the tongue or subtotal glossectomy was poorly intelligible (CI score 3) or generally unintelligible (CI score 4), with severe deterioration of daily speech.(4) There was no significant relation between the CI and the type of flap (forearm flap, pectoralis major myocutaneous flap, rectus abdominis myocutaneous flap) used for reconstruction of the tongue and mouth floor. However, a forearm flap was advantageous with respect to mobility of the tongue.(5) When reconstructing the tongue and mouth floor after hemiglossectomy or subtotal glossectomy, the first priority should be to obtain a sufficient volume (i. e., distention toward the palate) of the reconstructed tongue.