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Evaluating Sensation Recovery in Noninnervated Free Flaps Used for Oral Reconstruction. J Oral Maxillofac Surg 2023; 81:350-357. [PMID: 36592932 DOI: 10.1016/j.joms.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 11/26/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Association between time and sensation recovery in noninnervated flaps remains unclear. Our goal was to evaluate the recovery of sensation in noninnervated free flaps used for oral reconstruction. MATERIALS AND METHODS A prospective cohort study was designed and consecutive patients undergoing noninnervated free flap surgery for oral reconstruction from a tertiary medical center were enrolled. The primary outcome variable was sensory recovery of light touch, pain, hot, and cold temperature. Sensory recovery was scored as per the test on the central portion and 4 peripheral sections of every flap. The Kaplan-Meier method was used to estimate the functional recovery at different time points and the association between clinicopathologic variables and sensation recovery at 24 months after surgery was analyzed using the chi-squared test and logistic regression analysis. RESULTS Eighty patients were included with a median age of 50 years. At 3 months postoperatively, no patients exhibited sensation recovery. Positive flap sensitivity began to appear mildly at 6 months postoperatively and gradually increased for at least 24 months. The 24-month sensation recovery rates of light touch, pain, and temperature were 70.0% (95% confidence interval [CI]: 59.2 to 78.9%), 42.5% (95% CI: 32.3 to 53.4%), and 33.8% (95% CI: 24.45 to 44.6%), respectively. In univariate analysis, 80.5% (95% CI: 66.0 to 89.8%) of the free radial forearm flaps showed light touch sensation recovery, which was statistically higher than 59.0% (95% CI: 43.4 to 72.9%) in other flaps (P = .036). Flap size ≤ 65 cm2 predicted better pain sensation recovery with 57.5% (95% CI: 42.2 to 71.5%) compared to 27.5% (95% CI: 16.1 to 42.8%) in flap size > 65 cm2 groups (P = .007). Logistic regression analysis confirmed flap size ≤ 65 cm2 (P = .032, odds ratio = 1.957, 95% CI: 1.034 to 4.389) and not smoking (P = .015, odds ratio = 2.564, 95% CI: 1.673-5.482) offered better sensation recovery of pain and hot temperature, respectively. CONCLUSIONS Sensation recovery in noninnervated free flaps was common and related to not smoking and flap size.
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Gavidia R, Dunietz GL, O'Brien L, Shannon C, Schuetz S, Spector M, Swiecicki P, Chervin RD. Obstructive sleep apnea in patients with head and neck cancer: a systematic review. J Clin Sleep Med 2021; 17:1109-1116. [PMID: 33560207 DOI: 10.5664/jcsm.9134] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Head and neck cancers (HNCs) may modify the upper airway anatomy and thereby increase the risk for obstructive sleep apnea (OSA). If untreated, OSA is associated with adverse outcomes. Identification of risk factors for OSA in patients with HNC is essential to promote proper evaluation, treatment, and improvement of sleep-related outcomes. In this review, we assessed associations between tumor stage, cancer treatment, and OSA in the population with HNC. METHODS A systematic search of PubMed, EMBASE (Embase.com), Cochrane Library (Cochranelibrary.com), Scopus, and Web of Science was conducted to identify articles related to OSA in patients with HNC. A total of 215 articles were identified, of which 14 were included in the qualitative synthesis. These studies included 387 participants. RESULTS The most common cancer type, tumor location, and cancer therapy were squamous cell carcinoma, oropharynx, and surgery, respectively. Three of six articles reported an association between surgical treatment and OSA. Conversely, associations between tumor stage, radiotherapy, and OSA were found in only a minority of studies (15%). The prevalence of OSA was between 57% and 76% pre-cancer therapy and 12% and 96% afterward. CONCLUSIONS This review suggests a potential association between HNC surgery and OSA. An association between tumor stage, radiotherapy to the head and neck, and OSA is inconclusive. Further research is needed to examine the relationship between HNC and OSA.
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Affiliation(s)
- Ronald Gavidia
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Galit Levi Dunietz
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Louise O'Brien
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Carol Shannon
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Sonja Schuetz
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Matthew Spector
- Department of Otolaryngology and Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Paul Swiecicki
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ronald D Chervin
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
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Vaira LA, Massarelli O, Gobbi R, Biglio A, De Riu G. Tactile recovery assessment with shortened Semmes-Weinstein monofilaments in patients with buccinator myomucosal flap oral cavity reconstructions. Oral Maxillofac Surg 2018; 22:151-156. [PMID: 29396784 DOI: 10.1007/s10006-018-0682-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/25/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The sensitive restoration is a primary aim of oral reconstructive surgery. The Semmes-Weinstein monofilament test is the "Gold Standard" to assess the threshold of tactile sensitivity on the skin but its use in the oral cavity is limited due to the size of the tools. We adopted half-cut Semmes-Weinstein monofilaments to evaluate the threshold of tactile sensitivity in oral reconstructions with buccinator myomucosal flaps. MATERIALS AND METHODS Monofilaments were half-cut and recalibrated. Fifty-seven oral reconstructions were considered at 4-year minimum follow-up. Test was conducted both on the reconstructive flap and on the non-operated contralateral side. RESULTS All of the considered flaps (100%) showed a recovery of tactile sensitivity. The overall average tactile threshold value assessed on this sample was 0.76 ± 1.58 g/mm2 overall. CONCLUSIONS Shortened monofilaments allow easily assessment of tactile sensitivity in all the oral cavity areas, even in operated patients which often present lockjaw or microstomia.
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Affiliation(s)
- Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy.
| | - Olindo Massarelli
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Roberta Gobbi
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Andrea Biglio
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
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Loth A, Michel J, Giorgi R, Santini L, Rey M, Elbaum JM, Roux N, Giovanni A, Dessi P, Fakhry N. Prevalence of obstructive sleep apnoea syndrome following oropharyngeal cancer treatment: A prospective cohort study. Clin Otolaryngol 2017; 42:1281-1288. [DOI: 10.1111/coa.12869] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 12/27/2022]
Affiliation(s)
- A. Loth
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
| | - J. Michel
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
| | - R. Giorgi
- IRD; UMR_S 912 (SESSTIM); Aix-Marseille Université; Marseille France
- INSERM; UMR_S 912 (SESSTIM); Marseille France
- Service Biostatistiques et Technologies de l'Information et de la Communication; Hôpital Timone; APHM; Marseille France
| | - L. Santini
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
| | - M. Rey
- Centre du sommeil et Service de Neurophysiologie Clinique; Hôpital Timone; APHM; Marseille France
| | - J.-M. Elbaum
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
| | - N. Roux
- Service Biostatistiques et Technologies de l'Information et de la Communication; Hôpital Timone; APHM; Marseille France
| | - A. Giovanni
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
- Laboratoire Parole et Langage (LPL); CNRS UMR; Aix-Marseille Université; Aix-en-Provence France
| | - P. Dessi
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
| | - N. Fakhry
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
- Laboratoire Parole et Langage (LPL); CNRS UMR; Aix-Marseille Université; Aix-en-Provence France
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Vaira LA, Massarelli O, Gobbi R, Soma D, Dell’aversana Orabona G, Piombino P, De Riu G. Evaluation of discriminative sensibility recovery in patients with buccinator myomucosal flap oral cavity reconstructions. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1277-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Namin AW, Varvares MA. Functional outcomes of sensate versus insensate free flap reconstruction in oral and oropharyngeal reconstruction: A systematic review. Head Neck 2016; 38:1717-1721. [DOI: 10.1002/hed.24494] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 02/13/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Arya W. Namin
- Department of Surgery; University of Texas Southwestern Medical Center; Dallas Texas
| | - Mark A. Varvares
- Department of Otolaryngology - Head and Neck Surgery; Massachusetts Eye and Ear Infirmary and Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts
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George RK, Krishnamurthy A. Microsurgical free flaps: Controversies in maxillofacial reconstruction. Ann Maxillofac Surg 2013; 3:72-9. [PMID: 23662264 PMCID: PMC3645616 DOI: 10.4103/2231-0746.110059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Reconstructive microsurgery for oral and maxillofacial (OMF) defects is considered as a niche specialty and is performed regularly only in a handful of centers. Till recently the pectoralis major myocutaneous flap (PMMC) was considered to be the benchmark for OMF reconstruction. This philosophy is changing fast with rapid advancement in reconstructive microsurgery. Due to improvement in instrumentation and the development of finer techniques of flap harvesting we can positively state that microsurgery has come of age. Better techniques, microscopes and micro instruments enable us to do things previously unimaginable. Supramicrosurgery and ultrathin flaps are a testimony to this. Years of innovation in reconstructive microsurgery have given us a reasonably good number of very excellent flaps. Tremendous work has been put into producing some exceptionally brilliant research articles, sometimes contradicting each other. This has led to the need for clarity in some areas in this field. This article will review some controversies in reconstructive microsurgery and analyze some of the most common microvascular free flaps (MFF) used in OMF reconstruction. It aims to buttress the fact that three flaps-the radial forearm free flap (RFFF), anterolateral thigh flap (ALT) and fibula are the ones most expedient in the surgeon's arsenal, since they can cater to almost all sizeable defects we come across after ablative surgery in the OMF region. They can thus aptly be titled as the workhorses of OMF reconstruction with regard to free flaps.
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Affiliation(s)
- Rinku K George
- Department of Head & Neck Oncology & Reconstructive Surgery, Cancer Institute (W.I.A), Adyar, Chennai, India
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8
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Gilat H, Shpitzer T, Guttman D, Soudry E, Feinmesser R, Bachar G. Obstructive sleep apnea after radial forearm free flap reconstruction of the oral tongue. Laryngoscope 2013; 123:3223-6. [PMID: 23575744 DOI: 10.1002/lary.24125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 02/21/2013] [Accepted: 03/05/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine whether radial forearm free flap reconstruction of the tongue after partial glossectomy is associated with obstructive sleep apnea. STUDY DESIGN Retrospective case series. METHODS Fifteen patients (5 men, 10 women) treated for tongue cancer in 2006-2010 by partial glossectomy and immediate radial forearm free flap reconstruction completed the Epworth Sleepiness Scale and underwent polysomnographic studies. Background, clinical, and pathologic data were collected from the medical files. RESULTS Mean ± SD age of the study group was 57 ± 19 years; body mass index, 24 ± 4; follow-up, 5.6 ± 2.8 years. Mean ± SD Epworth scale score was 8.18 ± 6.18 (normal, <8). Disordered sleep was documented in 11 patients, of whom 8 (53.3% of the cohort) had OSA (5 mild, 2 moderate, 1 severe). The OSA rate was significantly higher than reported in the general population (P = 0.001). CONCLUSION Patients after partial glossectomy and radial forearm free flap reconstruction appear to be at high risk of obstructive sleep apnea. Testing for OSA should be considered in these patients.
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Affiliation(s)
- Hanna Gilat
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Mitchell O, Durrani A, Price R. Rehabilitation of patients following major head and neck cancer surgery. ACTA ACUST UNITED AC 2012; 21:S31-7. [DOI: 10.12968/bjon.2012.21.sup10.s31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Amer Durrani
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge
| | - Richard Price
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge
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10
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ELFRING TT, BOLIEK CA, SEIKALY H, HARRIS J, RIEGER JM. Sensory outcomes of the anterior tongue after lingual nerve repair in oropharyngeal cancer. J Oral Rehabil 2011; 39:170-81. [DOI: 10.1111/j.1365-2842.2011.02253.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Loewen IJ, Boliek CA, Harris J, Seikaly H, Rieger JM. Oral sensation and function: a comparison of patients with innervated radial forearm free flap reconstruction to healthy matched controls. Head Neck 2010; 32:85-95. [PMID: 19536773 DOI: 10.1002/hed.21155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Limited evidence exists for the use of innervated radial forearm free flap (RFFF) reconstruction of hemiglossectomy defects. This study reports on sensation, mastication, and speech outcomes for patients with innervated RFFF reconstruction of the anterior two-thirds of the tongue. METHODS Sensation, mastication, and speech intelligibility were assessed in 8 patients and age- and sex-matched controls. RESULTS Sensation of intact tongue tissue after reconstruction of the hemitongue did not differ from controls. Although some sensory ability was restored to patients' reconstructed tongue, differences existed between the patient group and controls. However, whole mouth sensations resulted in similar sensory ability as controls. Whereas patients demonstrated adequate masticatory and speech ability, differences existed between patients and controls. CONCLUSION Although some sensory ability is preserved in patients who have had tongue reconstruction with an innervated RFFF, functional outcomes such as masticatory ability and speech intelligibility may be affected in some patients.
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Affiliation(s)
- Irene J Loewen
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Alberta, Canada.
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12
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Smith RB, Sniezek JC, Weed DT, Wax MK. Utilization of free tissue transfer in head and neck surgery. Otolaryngol Head Neck Surg 2007; 137:182-91. [PMID: 17666238 DOI: 10.1016/j.otohns.2007.04.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 03/19/2007] [Accepted: 04/18/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Free tissue transfer is frequently incorporated into the reconstructive algorithm for a multitude of defects in the head and neck. With the increasing usage of free tissue transfer we undertook to review the most current advances in the field. DATA SOURCES PubMed search of all pertinent articles as they related to oropharyngeal reconstruction, flap choice, new technologies and techniques, and outcomes. Articles were chosen based on reviewer selection. METHODS The microvascular committee met and discussed the current important topics in free tissue transfer. A priority list was created and ranked. Topics were assigned to the authors who conducted a narrative review of the literature. RESULTS Free tissue transfer has evolved to the point where a limited number of specific flaps are now utilized for most defects. Composite tissue is used to reconstruct composite defects. The coupling device and implantable Doppler are demonstrating a positive impact on flap survival and efficiency. Finally, outcomes in terms of quality of life, swallowing, and return to function have been shown to improve with the use of free tissue transfer. CONCLUSION Free tissue transfer continues to be the reconstructive modality of choice for head and neck defects.
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Affiliation(s)
- Russell B Smith
- Department of Otolaryngology--Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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13
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Boliek CA, Rieger JM, Li SYY, Mohamed Z, Kickham J, Amundsen K. Establishing a reliable protocol to measure tongue sensation. J Oral Rehabil 2007; 34:433-41. [PMID: 17518978 DOI: 10.1111/j.1365-2842.2007.01735.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The relationship between tongue sensation and tongue function for speech, mastication and deglutition are growing areas of interest among rehabilitative professionals. To determine the potential effect that sensation has on function, it is imperative that, first, reliable and valid measures of tongue sensation be established. The aim of this study was to develop a protocol to test tongue sensation across a spectrum of sensory functions that included two-point discrimination, light-touch discrimination, thermal sensation, texture recognition, oral stereognosis and taste recognition. Materials tested within each domain respectively included: (i) the MacKinnon-Dellon Disk-criminator, paperclip and caliper; (ii) the Semmes-Weinstein monofilament and cotton wisp; (iii) dental mirrors and glass test tubes; (iv) spheres of textured acrylic resin on rods; (v) acrylic resin forms with differing shapes on rods and (vi) salty, sweet, sour, bitter and neutral solutions. Materials were tested on 40 healthy subjects between the ages of 20 and 55. The results from this study indicated that thermal, texture and taste sensations appear robust for accuracy and discrimination. Two-point discrimination and light touch seem to be influenced by location of stimulation on the tongue and force applied, whereas stereognosis was influenced by stimulus complexity. The results of this study indicate that clinicians may choose instruments as practical as paperclips and test tubes for testing two-point discrimination and thermal sensation, respectively. For the other sensations, it may be important to use more sophisticated instrumentation to control variables of force, surface area stimulated and assessing sensations in graded steps.
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Affiliation(s)
- C A Boliek
- Department of Speech Pathology & Audiology, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
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14
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Kerawala CJ, Newlands C, Martin I. Spontaneous sensory recovery in non-innervated radial forearm flaps used for head and neck reconstruction. Int J Oral Maxillofac Surg 2006; 35:714-7. [PMID: 16697143 DOI: 10.1016/j.ijom.2006.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Revised: 02/06/2006] [Accepted: 03/13/2006] [Indexed: 11/20/2022]
Abstract
Although several studies have reported the use of reinnervated microvascular free flaps for oro-pharyngeal reconstruction, it has been known for some time that non-innervated flaps demonstrate spontaneous sensory recovery. This study sought to evaluate the degree of such spontaneous recovery in 50 radial forearm flaps used for mucosal reconstruction of head and neck ablative defects. The recovery of sensation to pinprick, light touch and temperature was tested a mean of 38 months (range 15-71) after surgical insetting. Two-point discrimination was also sought. Although 18 flaps (36%) remained anaesthetic, partial recovery in one or more modalities was present in 28 patients (56%). A recovery in all modalities of sensation in at least two-thirds of the flap area was recorded in 4 patients (8%). The mean 2-point static discrimination for fascio-cutaneous flaps was 18.9mm.
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Affiliation(s)
- C J Kerawala
- Department of Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK.
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15
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Avery CME, Iqbal M, Hayter JP. Recovery of sensation in the skin of non-innervated radial flaps after subfascial and suprafascial dissection. Br J Oral Maxillofac Surg 2006; 44:213-6. [PMID: 16061309 DOI: 10.1016/j.bjoms.2005.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Accepted: 06/12/2005] [Indexed: 11/18/2022]
Abstract
We compared the extent of recovery of sensation in 40 non-innervated radial free flaps, 20 of which had been raised subfascially and 20 suprafascially. We found no significant difference in sensory recovery between the two groups. The mean extent of sensory recovery was light touch (68%); sharp touch (84%); warm (29%) and cold (40%) temperature; and static (25%) and moving (31%) two-point discrimination. Nearly all the flaps responded to at least one stimulus (excluding two-point discrimination) and half of them to three or more. Sharp touch sensation in the flap was similar to that in the surrounding tissues and light touch was less sensitive. There was no dysaesthesia. Recovery was not related to sex, age, alcohol consumption, or site of reconstruction. Smoking and radiotherapy had a slight effect.
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Affiliation(s)
- C M E Avery
- Department of Maxillofacial Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK.
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Smith GI, O'Brien CJ, Choy ET, Andruchow JL, Gao K. Clinical outcome and technical aspects of 263 radial forearm free flaps used in reconstruction of the oral cavity. Br J Oral Maxillofac Surg 2005; 43:199-204. [PMID: 15888352 DOI: 10.1016/j.bjoms.2004.11.024] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to report the applications, complications, and limitations of the radial forearm flap when used for reconstruction after excision of cancers in the mouth. PATIENTS AND METHODS We reviewed records in our database from October 1987 to December 2002; a total of 505 patients had surgical defects of the head and neck reconstructed with a radial forearm flap: 258 patients had oral cancers, of whom 173 were men and 85 women, median age was 70 years. Five patients had two reconstructions (total 263), of which 247 were fasciocutaneous and 16 osseofasciocutaneous flaps. Mucosal squamous carcinoma accounted for 97% of the primary cancers. RESULTS There were nine failures of the flap (3.4%) and four episodes of partial necrosis. Four patients (2%) died within 30 days of operation. Orocutaneous fistulas appeared in nine patients (3.4%), 10 patients had wound infections, and nine had haematomas. The nine failed flaps were replaced by a second free flap in one patient, a pectoralis major flap in three, a buccinator myomucosal flap in one, a skin graft in one, and the remaining three defects healed by secondary intention. There was one failure and one partial failure among the 16 osseofasciocutaneous flaps.
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Affiliation(s)
- G I Smith
- Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
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17
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Hitchings A, Murray A. Traumatic Ulceration Mimicking Oral Squamous Cell Carcinoma Recurrence in an Insensate Flap. EAR, NOSE & THROAT JOURNAL 2004. [DOI: 10.1177/014556130408300316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report our experience with a patient who developed an ulcer within a free flap 2 months following resection of an oral squamous cell carcinoma. We discuss this clinical problem and the issues it raised, with particular attention to early tumor recurrence and the restoration of sensation in free-flap reconstructions.
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Affiliation(s)
- Anne Hitchings
- Department of Otolaryngology–Head and Neck Surgery, Crosshouse Hospital, Kilmarnock, U.K
| | - Andrew Murray
- Department of Otolaryngology–Head and Neck Surgery, Crosshouse Hospital, Kilmarnock, U.K
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18
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Quante M, Lorenz J, Vesper M, Bretschneider B, Schmelzle R, Bromm B. Sensory reinnervation of myocutaneous flaps revealed by infrared laser evoked sensations and brain potentials. Neurorehabil Neural Repair 2003; 17:58-65. [PMID: 12645446 DOI: 10.1177/0095399702250446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to examine the recovery of sensory function in myocutaneous flaps comparing 2 test methods. Eight flaps in 7 patients were examined by using clinical neurological test procedures (CNT) in comparison with psychophysics and evoked brain potentials (LEP) following infrared laser stimuli. The authors found that only 3 out of 8 flaps in 7 patients exhibited signs of reinnervation when tested with CNT. Three grades of reinnervation appeared in 7 flaps when tested with the laser. Grade 1 indicated the recovery of unmyelinated C-fiber function in 7 flaps accounting for the ability to discriminate laser intensities by different degrees of warmth. Grade 2 appeared in 3 of these flaps and was characterized by the additional ability to sense pinprick pain and the elicitation of late components of LEP mediated by thinly myelinated A delta-nociceptors. Grade 3 involved the additional sensibility for superficial touch indicating the recovery of thickly myelinated A beta-fibers noted in 2 of these flaps. The authors conclude that the LEP method is more sensitive than standard neurological test procedures to objectively document early signs of reinnervation after reconstructive flap surgery. This result is promising to investigate greater patient populations comparing different surgical techniques in future studies.
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Affiliation(s)
- Markus Quante
- Institute for Physiology, University Hospital Eppendorf, Martinistrasse 52, D-20246 Hamburg
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Surgical principles and techniques for functional rehabilitation after oral cavity and oropharyngeal oncologic surgery. Curr Opin Otolaryngol Head Neck Surg 2001. [DOI: 10.1097/00020840-200104000-00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morton RP, Chaplin JM. Where are we with clinical outcomes in head and neck cancer? Curr Opin Otolaryngol Head Neck Surg 2000. [DOI: 10.1097/00020840-200004000-00005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Civantos FJ, Roth J, Goodwin WJ, Weed DT. Sensory recovery in melolabial flaps used for oral cavity reconstruction. Otolaryngol Head Neck Surg 2000; 122:509-13. [PMID: 10740169 DOI: 10.1067/mhn.2000.103536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Current literature advocates the use of complex reinnervated free flaps to re-establish oral sensation after resection of oral cavity cancers. It has been demonstrated that noninnervated flaps can also re-establish sensation. We assessed the return of sensation in local melolabial flaps used in oral reconstruction. Seven patients underwent sensory testing at intervals from 12 to 18 months after surgery. The ability to distinguish differences in temperature was present in all patients. Spontaneous return of sensitivity to touch was documented by clinical testing in 71% of the patients. Less return of sensation was seen in flaps used for defects of the buccal mucosa relative to the floor of mouth. We conclude that spontaneous return of flap sensation does occur with local melolabial flaps. Given the simplicity of these procedures, melolabial flaps represent a reasonable alternative in floor-of-mouth reconstruction for selected patients.
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Affiliation(s)
- F J Civantos
- University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Department of Otolaryngology, University of Miami School of Medicine, Miami, FL 33136, USA
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