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Chepeha DB, Barbon CEA, Esemezie AO, Al Mardini M, Philteos J, Spector ME, Bressmann T, Martino R, Bratman SV, Cho JBC, Hope AJ, Hosni AA, Kim JJH, Ringash JG, Waldron JN, Brown DH, de Almeida JR, Gilbert RW, Goldstein DP, Gullane PJ, Irish JC, Monteiro EA, Yao CMKL. Telemedicine-enabled biofeedback electropalatography rehabilitation (TEBER): A pilot study for patients treated with surgery for oral cavity carcinoma. Head Neck 2024. [PMID: 38561946 DOI: 10.1002/hed.27721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/22/2024] [Accepted: 02/24/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND To address the rehabilitative barriers to frequency and precision of care, we conducted a pilot study of a biofeedback electropalatography (EPG) device paired with telemedicine for patients who underwent primary surgery +/- adjuvant radiation for oral cavity carcinoma. We hypothesized that lingual optimization followed by telemedicine-enabled biofeedback electropalatography rehabilitation (TEBER) would further improve speech and swallowing outcomes after "standard-of-care" SOC rehabilitation. METHOD Pilot prospective 8-week (TEBER) program following 8 weeks of (SOC) rehabilitation. RESULTS Twenty-seven patients were included and 11 completed the protocol. When examining the benefit of TEBER independent of standard of care, "range-of-liquids" improved by +0.36 [95% CI, 0.02-0.70, p = 0.05] and "range-of-solids" improved by +0.73 [95% CI, 0.12-1.34, p = 0.03]. There was a positive trend toward better oral cavity obliteration; residual volume decreased by -1.2 [95% CI, -2.45 to 0.053, p = 0.06], and "nutritional-mode" increased by +0.55 [95% CI, -0.15 to 1.24, p = 0.08]. CONCLUSION This pilot suggests that TEBER bolsters oral rehabilitation after 8 weeks of SOC lingual range of motion.
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Affiliation(s)
- Douglas B Chepeha
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Carly E A Barbon
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alex O Esemezie
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Majd Al Mardini
- Department of Dentistry, Maxillofacial and Ocular Prosthetics, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Matthew E Spector
- Department of Otolaryngogy-Head & Neck Surgery, University of Pittsburgh, Pittsburgh, Pensylvania, USA
| | - Tim Bressmann
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Rosemary Martino
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - John B C Cho
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Andrew J Hope
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Ali Abdalati Hosni
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - John J H Kim
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Jolie G Ringash
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - John N Waldron
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Dale H Brown
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Patrick J Gullane
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eric A Monteiro
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Tienkamp TB, Rebernik T, Halpern BM, van Son RJJH, Wieling M, Witjes MJH, de Visscher SAHJ, Abur D. Quantifying Articulatory Working Space in Individuals Surgically Treated for Oral Cancer With Electromagnetic Articulography. J Speech Lang Hear Res 2024; 67:384-399. [PMID: 38289853 DOI: 10.1044/2023_jslhr-23-00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE The purpose of this study was to quantify sentence-level articulatory kinematics in individuals treated for oral squamous cell carcinoma (ITOC) compared to control speakers while also assessing the effect of treatment site (jaw vs. tongue). Furthermore, this study aimed to assess the relation between articulatory-kinematic measures and self-reported speech problems. METHOD Articulatory-kinematic data from the tongue tip, tongue back, and jaw were collected using electromagnetic articulography in nine Dutch ITOC and eight control speakers. To quantify articulatory kinematics, the two-dimensional articulatory working space (AWS; in mm2), one-dimensional anteroposterior range of motion (AP-ROM; in mm), and superior-inferior range of motion (SI-ROM in mm) were calculated and examined. Self-reported speech problems were assessed with the Speech Handicap Index (SHI). RESULTS Compared to a sex-matched control group, ITOC showed significantly smaller AWS, AP-ROM, and SI-ROM for both the tongue tip and tongue back sensor, but no significant differences were observed for the jaw sensor. This pattern was found for both individuals treated for tongue and jaw tumors. Moderate nonsignificant correlations were found between the SHI and the AWS of the tongue back and jaw sensors. CONCLUSIONS Despite large individual variation, ITOC showed reduced one- and two-dimensional tongue, but not jaw, movements compared to control speakers and treatment for tongue and jaw tumors resulted in smaller tongue movements. A larger sample size is needed to establish a more generalizable connection between the AWS and the SHI. Further research should explore how these kinematic changes in ITOC are related to acoustic and perceptual measures of speech.
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Affiliation(s)
- Thomas B Tienkamp
- Center for Language and Cognition Groningen, University of Groningen, the Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, the Netherlands
- Research School of Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands
| | - Teja Rebernik
- Center for Language and Cognition Groningen, University of Groningen, the Netherlands
- Research School of Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Bence M Halpern
- Netherlands Cancer Institute, Amsterdam, the Netherlands
- Amsterdam Center for Language and Communication, University of Amsterdam, the Netherlands
- Multimedia Computing Group, Delft University of Technology, the Netherlands
| | - Rob J J H van Son
- Netherlands Cancer Institute, Amsterdam, the Netherlands
- Amsterdam Center for Language and Communication, University of Amsterdam, the Netherlands
| | - Martijn Wieling
- Center for Language and Cognition Groningen, University of Groningen, the Netherlands
- Research School of Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands
- Haskins Laboratories, New Haven, CT
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, the Netherlands
| | | | - Defne Abur
- Center for Language and Cognition Groningen, University of Groningen, the Netherlands
- Research School of Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands
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Chepeha DB, Esemezie AO, Philteos J, Brown DH, de Almeida JR, Gilbert RW, Goldstein DP, Gullane PJ, Irish JC, Yao CM, Barbon CEA. Glossectomy for the treatment of oral cavity carcinoma: Quantitative, functional and patient-reported quality of life outcomes differ by four glossectomy defects. Oral Oncol 2023; 142:106431. [PMID: 37263070 DOI: 10.1016/j.oraloncology.2023.106431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The goal was to characterize four clinically distinct glossectomy defects to establish significant quantitative cut points using functional metrics, the MD Anderson Dysphagia Index (MDADI) and speech intelligibility. METHODS Population included 101 patients treated with surgery, adjuvant radiation per NCCN guidelines, and ≥ 12 months follow-up. RESULTS Defect groups: subtotal hemiglossectomy (1), hemiglossectomy (2), extended hemiglossectomy (3) and oral glossectomy (4) were compared: All outcomes supported a four defect model. Intergroup comparison of outcomes with subtotal hemiglossectomy as reference (p value): Tongue Protrusion <0.001,<0.001,<0.001; Elevation <0.001,<0.001,<0.001; Open Mouth Premaxillary Contact Elevation <0.001,<0.001,<0.001; Obliteration 0.6,<0.001,<0.001; Normalcy of Diet, <0.3,<0.001,<0.001; Nutritional Mode, <0.9,<0.8,<0.001; Range of Liquids, <0.4,<0.016,<0.02; Range of Solids, <0.5,<0.004,<0.001; Eating in Public, <0.2,<0.002,<0.03; Understandability of Speech, <0.9,<0.001,<0.001; Speaking in Public, <0.4,<0.03,<0.001; MDADI, <0.4,<0.005,<0.01; Single Word Intelligibility, <0.4,<0.1,<0.001; Sentence Intelligibility, <0.5,<0.08,<0.001; Words Per Minute Intelligibility, <0.6,<0.04,<0.001; Sentence Efficiency Ratio, <0.4,<0.03,<0.002. Proportion of patients by 4 defect groups who underwent: tissue transplantation, 51%,93.9%,100%,100%.Radiation,24%,67%,88%,80%.Between hemiglossectomy and extended hemiglossectomy, the defect extends into the contralateral floor of the mouth and/or the anterior tonsillar pillar; resection of these subunits limits tongue mobility with an impact on functional outcome and MDADI. Between extended hemiglossectomy and oral glossectomy, the defect extends to include the tip of the tongue and appears to impact functional outcome and MDADI. CONCLUSIONS Subtotal hemiglossectomy, hemiglossectomy, extended glossectomy and oral glossectomy are associated with quantitative (elevation, protrusion, open mouth premaxillary contact and obliteration), qualitative (speech and swallowing) and MDADI differences, suggesting that these 4 ordinal defect groups are distinct.
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Affiliation(s)
- Douglas B Chepeha
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Michigan Health System, Ann Arbor, MI, United States.
| | - Alex O Esemezie
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dale H Brown
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Patrick J Gullane
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Christopher Mkl Yao
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Carly E A Barbon
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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4
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Marchiano E, Kana L, Bellile E, Smith JD, Casper KA, Malloy KM, Chinn SB, Stucken CL, Prince MEP, Chepeha DB, Rosko AJ, Spector ME. Neurotization of the radial forearm free flap improves swallowing outcomes in hemiglossectomy defects. Head Neck 2023; 45:798-805. [PMID: 36579434 DOI: 10.1002/hed.27290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/22/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We examined the effect of free tissue neurotization on speech and swallowing outcomes for patients undergoing reconstruction of hemiglossectomy defects with a radial forearm free flap (RFFF). METHODS A retrospective study was performed in patients with oral cavity squamous cell carcinoma undergoing a hemiglossectomy and reconstruction with a RFFF. Functional outcomes including nutritional mode, range of liquids and solids, and speech understandability were analyzed 1-year post-treatment. RESULTS Eighty-four patients were included in this analysis, 41 of whom had neurotized flaps (49%). No significant differences in demographic or clinical variables were seen between the neurotized and non-neurotized groups. On multivariate analysis controlling for BMI, flap area, and N-classification, patients with neurotized flaps were significantly more likely to have normal range of liquids and solids and less likely to have a G-tube. CONCLUSIONS Neurotization of RFFF reconstructing hemiglossectomy defects results in decreased G-tube dependence and improved range of liquids and solids.
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Affiliation(s)
- Emily Marchiano
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Lulia Kana
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Emily Bellile
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joshua D Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Keith A Casper
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Steven B Chinn
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mark E P Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Douglas B Chepeha
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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Choi JW, Alshomer F, Kim YC. Current status and evolution of microsurgical tongue reconstructions, part I. Arch Craniofac Surg 2022; 23:139-151. [PMID: 36068689 PMCID: PMC9449093 DOI: 10.7181/acfs.2022.00654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Reconstructive surgery in the management of head and neck cancer has evolved to include structure-specific approaches in which organ-specific treatment algorithms help optimize outcomes. Tongue cancer management and reconstruction are surgical challenges for which well-executed reconstructive plans should be completed promptly to avoid delaying any subsequently planned oncologic treatment. Crucial considerations in tongue cancer resection are the significant functional morbidity associated with surgical defects, particularly in terms of speech and swallowing, and the consequent negative impact on patients’ quality of life. With the evolution of microsurgical techniques and the development of the perforator flap concept, flap options can be tailored to the characteristics of various tongue defects. This has allowed the implementation of pliable flaps that can help restore tongue mobility and yield subsequent functional outcomes. Using an evolutional framework, we present this series of reviews related to tongue reconstruction. The first part of the review summarizes flap options and flap-related factors, such as volume and tissue characteristics. Related functional aspects are also presented, including tongue mobility, speech, and swallowing, as well as ways to evaluate and optimize these outcomes.
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Affiliation(s)
- Jong-Woo Choi
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Feras Alshomer
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Chul Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Han S, Hong X, Li H, Han W. Utility of a palatal speech appliance combined with the five-point eight-line segment technique in total tongue reconstruction. Int J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.ijom.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/20/2021] [Accepted: 01/05/2022] [Indexed: 11/19/2022]
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Gilbert RW. Reconstruction of the oral cavity; past, present and future. Oral Oncol 2020; 108:104683. [DOI: 10.1016/j.oraloncology.2020.104683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
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8
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Dziegielewski PT, Rieger J, Shama MA, O'connell DA, Harris JR, Seikaly H. Beavertail modification of the radial forearm free flap in total oral glossectomy reconstruction: Technique and functional outcomes. Oral Oncol 2019; 96:71-6. [DOI: 10.1016/j.oraloncology.2019.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/14/2019] [Accepted: 07/05/2019] [Indexed: 11/22/2022]
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Baskin RM, Seikaly H, Sawhney R, Danan D, Burt M, Idris S, Shama M, Boyce B, Dziegielewski PT. Tongue reconstruction: Rebuilding mobile three-dimensional structures from immobile two-dimensional substrates, a fresh cadaver study. Head Neck 2019; 41:3693-3699. [PMID: 31347741 DOI: 10.1002/hed.25889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/13/2019] [Accepted: 07/11/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To determine the two-dimensional (2D) characteristics of flaps necessary to create three-dimensional (3D) tongue anatomy. METHODS Dissection of 11 fresh, nonpreserved human cadavers was performed. Six defects in each were created: total tongue, total oral tongue, hemiglossectomy, oral hemiglossectomy, total base of tongue, and hemi-base of tongue. The resections were debulked to create flat, 2D mucosal flaps. The dimensions and shapes of these flaps were determined. RESULTS Each specimen showed consistent dimensions and geometry between cadavers. The total tongue was pear-shaped, the total oral tongue was egg-shaped, the oral hemi-tongue was bullet-shaped, the hemi-tongue resembled a dagger, the total base of tongue was rectangular, and the hemi-base of tongue was hour-glass shaped. CONCLUSION Typical dimensions and shapes of common tongue defects were determined. It is conceivable that customizing reconstructive flaps based on these data will increase the accuracy of neo-tongue reconstruction, and thus, improve functional outcomes.
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Affiliation(s)
- R Michael Baskin
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Raja Sawhney
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Deepa Danan
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Martha Burt
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Sherif Idris
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed Shama
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Brian Boyce
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida.,Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.,University of Florida Health Cancer Center, Gainesville, Florida
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Sakakibara A, Kusumoto J, Sakakibara S, Hasegawa T, Akashi M, Minamikawa T, Furudoi S, Hashikawa K, Komori T. Effect of size difference between hemiglossectomy and reconstruction flap on oral functions: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2019; 72:1135-1141. [PMID: 30930123 DOI: 10.1016/j.bjps.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/12/2019] [Accepted: 03/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Forearm free flaps are used after hemiglossectomy. However, no investigation has been performed on whether oral functions are better preserved when sizes of the resection and reconstruction flap are exact matches, or whether the size of the resection should be changed. We aimed to retrospectively examine whether size differences between the resection and reconstruction flap affect speech and swallowing functions postoperatively, and to determine whether there are more favorable flap size ratios. METHODS This is a retrospective cohort study of patients undergoing hemiglossectomy using a forearm free flap between 2006 and 2016 at Kobe University Hospital, Japan. The effect of size difference between the resection and reconstruction flap on maintained oral function was assessed. Speech and swallowing functions were assessed, and their correlation with the ratio of the flap size to that of the resected area was determined. With these data, distribution maps of the relationship between the functional level and reconstructed dimension ratio were prepared. The more suitable reconstructed dimension ratio was examined and evaluated. The Fisher exact test, Kruskal-Wallis test, and Scheffe test were used in statistical analyses. RESULTS Eighty-eight patients underwent hemiglossectomy using a forearm free flap during a 10-year period. Of these cases, 66 patients were included in this study, while 22 were excluded. The ratio of the area of the reconstruction flap to that of the resection site was 0.59-2.79 (median: 1.61). Sixty patients had flaps greater than the resection area, whereas 6 had smaller flaps. Significant differences were found in speech intelligibility and swallowing function when the reconstructed dimension ratio was categorized as follows: ≤1.3, 1.3-1.8, and ≥1.8. CONCLUSION Our findings suggest that postoperative deterioration of oral functions after hemiglossectomy could be reduced if reconstruction is performed using a forearm free flap with a surface area 1.3 to 1.8 times greater than that of the resection area.
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Affiliation(s)
- Akiko Sakakibara
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Sakakibara
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tsutomu Minamikawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shungo Furudoi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Weir-Mayta P, Spencer KA, Eadie TL, Yorkston K, Savaglio S, Woollcott C. Internally Versus Externally Cued Speech in Parkinson's Disease and Cerebellar Disease. Am J Speech Lang Pathol 2017; 26:583-595. [PMID: 28654941 PMCID: PMC5576967 DOI: 10.1044/2017_ajslp-16-0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/03/2016] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this study was to examine the effects of an internally versus externally cued speech task on perceived understandability and naturalness in speakers with Parkinson's disease (PD) and cerebellar disease (CD). METHOD Sentences extracted from a covertly recorded conversation (internally cued) were compared to the same sentences read aloud (externally cued) by speakers with PD and a clinical comparison group of speakers with CD. Experienced listeners rated the speech samples using a visual analog scale for the perceptual dimensions of understandability and naturalness. RESULTS Results suggest that experienced listeners rated the speech of participants with PD as significantly more natural and more understandable during the reading condition. Participants with CD were also rated as significantly more understandable during the reading condition, but ratings of naturalness did not differ between conversation and reading. CONCLUSIONS Speech tasks can have a pronounced impact on perceived speech patterns. For individuals with PD, both understandability and naturalness can improve during reading tasks versus conversational tasks. The speech benefits from reading may be attributed to several mechanisms, including possible improvement from an externally cued speech task. These findings have implications for speech task selection in evaluating individuals with dysarthria.
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Affiliation(s)
- Phil Weir-Mayta
- Department of Communication Sciences and Disorders, California State University, Fullerton
| | - Kristie A. Spencer
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Tanya L. Eadie
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Kathryn Yorkston
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Sara Savaglio
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Chris Woollcott
- Department of Speech and Hearing Sciences, University of Washington, Seattle
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Dawson C, Al-qamachi L, Martin T. Speech and swallowing outcomes following oral cavity reconstruction. Curr Opin Otolaryngol Head Neck Surg 2017; 25:200-4. [DOI: 10.1097/moo.0000000000000359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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