Objective evaluation of postoperative function in patients who underwent reconstruction after ablation of cancer of the tongue and/or floor of the mouth

A multicenter study

Abstract

This multicenter study objectively evaluated postoperative speech and masticatory and swallowing functions in patients with cancer of the tongue/floor of the mouth who had undergone ablative surgery and reconstruction with a pedicled or vascularized free flap. A total of 150 patients from 13 Japanese institutions were enrolled and subsequently classified according to the site of resection into the following three groups: lateral (n = 109); anterior (n = 20); and combined (n = 21). The lateral group was further divided into three subgroups, and the anterior group into two subgroups, according to the size of resection. Reconstruction was accomplished by radial forearm flap (RFF) in 86 patients, rectus abdominis myocutaneous flap (RAMCF) in 29, pectoralis major myocutaneous flap (PMMCF) in 17, cervical island flap (CIF) in 7, anterior lateral thigh flap (ALTF) in 6, and others in 5. Postoperative function was evaluated objectively using speech and conversational intelligibility tests, a color-developing chewing gum test and pressure-sensitive sheets for mastication, and a water-swallowing test for swallowing.
The results showed that, in the L group, the size of resection influenced speech to some degree, but not masticatory function. Aspiration during water-deglutition could be observed in some patients who had undergone resection of a relatively small part of the tongue. Among patients who had undergone partial glossectomy, RFF or CIF showed better results than PMMCF in the chewing gum test. Relative merits of RAMCF or RFF were not clear in subjects with half resection of the anterior two-thirds of the tongue. Subjects with anterior lateral thigh flap showed better function in the hemiglossectomized group than those with other flaps.
In group A, resection size had little impact on speech function, but affected masticatory and swallowing function. RFF was more useful than RAMCF for maintaining swallowing function when resection was limited within one-third of the anterior part of the tongue.
Group C showed the lowest speech and masticatory functions. Regarding swallowing function, group C had better results than group A in the water-swallowing test, although the rate of aspiration was higher than that in the other groups. Donor sites had no effect on functional results.
These results suggest that we should aim to achieve higher functional level in patients with cancer of the tongue/floor of the mouth, refine suturing techniques for flaps, and clarify the usefulness of nerve preservation/reconstruction and elevation of the hyoid bone to increase the effectiveness of rehabilitation in the future.