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Cortina LE, Meyer CD, Feng AL, Lin DT, Deschler DG, Richmon JD, Varvares MA. Depth of resection predicts loss of tongue tip sensation after partial glossectomy in oral tongue cancer: A pilot study. Oral Oncol 2023; 147:106595. [PMID: 37837737 DOI: 10.1016/j.oraloncology.2023.106595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/06/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE(S) To characterize the change in sensory function following partial glossectomy for oral tongue cancer (OTC) and to identify predictors of loss of tongue-tip sensation (LoTTS). MATERIALS AND METHODS Patients with at least three months follow-up after partial glossectomy for primary OTC were included. All patients underwent a qualitative tongue sensation assessment and an objective tongue sensory exam of the native tongue tip. Additional details regarding the oncologic resection, surgical reconstruction, and pathological stage were collected. Multiple linear and logistic regressions were used for statistical analysis. RESULTS Sixty-four patients were enrolled, including 34 (53%) men with a median age of 65 at enrollment. Ten (15%) patients reported LoTTS. Increased depth of resection (DOR) was an independent predictor of LoTTS on multivariate analysis, with an increased risk at a threshold of 1.3 cm. LoTTS was also associated with worse subjective quality of life and perceptive speech performance in our qualitative tongue assessment. CONCLUSIONS In this pilot study, we found that DOR is a critical prognostic factor in predicting post treatment function. Patients with an increased DOR, particularly above 1.3 cm, are at greatest risk of LoTTS and associated morbidity. These findings may be used to predict post-operative sensory deficits, manage patients' expectations, and optimize the reconstructive approach. Future studies are needed to validate and replicate our results.
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Affiliation(s)
- Luis E Cortina
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Charles D Meyer
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Allen L Feng
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.
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2
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Quadri P, McMullen C. Oral Cavity Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00048-8. [PMID: 37164898 DOI: 10.1016/j.otc.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This summary provides a concise overview of oral cavity reconstruction to optimize functional outcomes in the modern era. Soft tissue and osseous reconstruction options for a wide range of oral cavity sites including lip, oral tongue, floor of mouth, buccal, hard palate, and composite oromandibular resections are reviewed. The appropriate applications of primary closure, secondary intention, skin grafts, and dermal substitute grafts are included. Anatomic considerations, indications, contraindications, and complications of local, regional, and free flaps in oral cavity reconstruction are discussed. Specific defects and the appropriate options for reconstruction of those defects are delineated.
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Affiliation(s)
- Pablo Quadri
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB - 6 Floor, Tampa, FL 33612, USA
| | - Caitlin McMullen
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB - 6 Floor, Tampa, FL 33612, USA.
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3
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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] [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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Dasgupta S, Samuel S. Assessment of Speech in Patients Undergoing Hemiglossectomy with Primary Closure and Radiotherapy - A Prospective Study. Ann Maxillofac Surg 2022; 12:157-160. [PMID: 36874774 PMCID: PMC9976854 DOI: 10.4103/ams.ams_76_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction The oral cavity plays a pivotal role in the generation of speech. The treatment of oral squamous cell carcinoma of the tongue requires an aggressive approach, combining resective surgery along with radiation therapy, with long-lasting effects on the patient's ability to speak. This study was designed to assess speech in subjects with carcinoma of the tongue following hemiglossectomy with primary closure and radiotherapy. Methods A prospective study was carried out in 20 subjects who underwent hemiglossectomy with primary closure for carcinoma of the tongue followed by radiotherapy. All subjects were evaluated for speech using 'Kannada Diagnostic Photo Articulation Test' before surgery, after surgery (on the 10th and 30th day), during radiation therapy after 15 fractions of radiation and after 1, 2 and 3 months following completion of radiotherapy. Statistical analysis was performed using SPSS software (v. 17.0). Significance levels were determined using ANOVA followed by Bonferroni correction. Results Intelligibility of speech was noted to be affected most at the one month follow-up visit after completion of radiotherapy (P < 0.001). The Kannada Diagnostic Photo Articulation Test proves to be a useful tool in assessing changes in speech, with results that can be replicated in further studies. Discussion The incidence of articulatory errors is increased following surgery and radiotherapy. Over time, the number of errors reduce and approach the baseline, indicating that although speech is indeed hampered by the treatment, with adequate speech therapy one can regain their preoperative articulation.
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Affiliation(s)
- Sohini Dasgupta
- Department of Oral and Maxillofacial Surgery, A B Shetty Memorial Institute of Dental Sciences (ABSMIDS), NITTE (Deemed to be University), Mangalore, Karnataka, India
| | - Soumi Samuel
- Department of Oral and Maxillofacial Surgery, A B Shetty Memorial Institute of Dental Sciences (ABSMIDS), NITTE (Deemed to be University), Mangalore, Karnataka, India
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5
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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; 51:1016-1021. [DOI: 10.1016/j.ijom.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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Preliminary Functional Outcomes and Quality of Life after Tongue Reconstruction with the Vastus Lateralis Myofascial Free Flap. Facial Plast Surg 2021; 37:681-687. [PMID: 33902114 DOI: 10.1055/s-0041-1726445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The aim of the present study is to report our preliminary experience with the vastus lateralis myofascial free flap (VLMFF) for tongue reconstruction according to tongue and donor site functional outcomes. Twelve consecutive patients (F: 5; median age: 54.0 years, interquartile range or IQR 42.75-69.0) were included. The validated European Organization for Research and Treatment of Cancer of the Head and Neck 35 Quality of Life Questionnaire (EORTC QLQ-H&N35) and the performance status scale for head and neck cancer (PSS-HN) questionnaires were used to assess the health-related quality of life (HRQOL). The lower extremity functional scale (LEFS) was used to self-report the donor area function. All patients were successfully treated, and no VLMFF failure was detected during a median follow-up period of 10.5 months (IQR: 6.5-33.0). The HRQOL showed a median EORTC QLQ-H&N35 score of 56.0 (IQR: 50.0-72.5). The median PSS-HN score was 80.0 (IQR: 45.0-95.0), 75.0 (IQR: 62.5-100.0), 75.0 (IQR: 62.5-100.0) for "Normalcy of Diet," "Public Eating," and "Understandability of Speech," respectively. The self-reported function of the lower extremities (donor area) showed a median LEFS of 59.0 (IQR: 32.5-74.0). This study reports optimistic data regarding the functional and quality of life outcomes after tongue reconstruction using VLMFF. Prospective controlled studies are needed to demonstrate advantages and disadvantages when compared with other reconstructive techniques.
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Bulbul MG, Wu M, Lin D, Emerick K, Deschler D, Richmon J, Goldsmith T, Zenga J, Puram SV, Varvares MA. Prediction of Speech, Swallowing, and Quality of Life in Oral Cavity Cancer Patients: A Pilot Study. Laryngoscope 2021; 131:2497-2504. [PMID: 33881173 DOI: 10.1002/lary.29573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/09/2021] [Accepted: 04/09/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the impact of specific treatment-related variables on functional and quality of life outcomes in oral cavity cancer (OCC) patients. STUDY DESIGN Retrospective Cohort. METHODS Patients with primary OCC at least 6 months after resection and adjuvant therapy were included. Patients completed surveys including the Speech Handicap Index (SHI), M.D. Anderson Dysphagia Inventory (MDADI), and Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN). Performance Status Scale (PSS) and tongue mobility scale were completed to allow provider-rated assessment of speech and tongue mobility, respectively. Additional details regarding treatment were also collected. These data were used to generate a predictive model using linear regression. RESULTS Fifty-three patients with oral tongue and/or floor of mouth (FOM) resection were included in our study. In multivariable analysis, greater postoperative tongue range of motion (ROM) and time since treatment improved SHI. Flap reconstruction and greater postoperative tongue ROM increased MDADI and PSS (eating and speech). A larger volume of resected tissue was inversely correlated with PSS (diet and speech). Tumor site was an important predictor of PSS (all sections). There were no statistically significant predictors of FACT-HN. CONCLUSIONS In this pilot study, we propose a battery of tools to assess function in OCC patients treated with surgery. Using the battery of tools we propose, our results show that a surgical endpoint that preserves tongue mobility and employs flap reconstruction resulted in better outcomes, whereas those with greater volume of tissue resected and FOM involvement resulted in poorer outcomes. Larger prospective studies are needed to validate our findings. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Mustafa G Bulbul
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Michael Wu
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Derrick Lin
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kevin Emerick
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniel Deschler
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeremy Richmon
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Tessa Goldsmith
- Department of Speech, language and swallowing disorders, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Joseph Zenga
- Department of Otolaryngology, Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Sidharth V Puram
- Department of Otolaryngology, Head and Neck Surgery Washington University in St Louis, St Louis, Missouri, U.S.A
| | - Mark A Varvares
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
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8
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Akakpo KE, Varvares MA, Richmon JD, McMullen C, Holcomb AJ, Rezaee R, Tamaki A, Curry J, Old MO, Kang SY, Graboyes EM, Gross J, Pipkorn P, Puram SV, Zenga J. The tipping point in oral cavity reconstruction: A multi-institutional survey of choice between flap and non-flap reconstruction. Oral Oncol 2021; 120:105267. [PMID: 33810989 DOI: 10.1016/j.oraloncology.2021.105267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Kenneth E Akakpo
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Jeremy D Richmon
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Caitlin McMullen
- Department of Otolaryngology-Head and Neck Surgery, Moffitt Cancer Center, Tampa, FL, United States
| | - Andrew J Holcomb
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Omaha, NE, United States
| | - Rod Rezaee
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Joseph Curry
- Department of Otolaryngology-Head and Neck Surgery, Jefferson University Hospitals, Philadelphia, PA, United States
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States; Department Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Jennifer Gross
- Department of Otolaryngology-Head and Neck Surgery, Emory School of Medicine, Atlanta, GA, United States
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, United States; Department of Genetics, Washington University School of Medicine, Saint Louis, MO, United States.
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States.
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Bhattacharya S, Thankappan K, Sukumaran SV, Mayadevi M, Balasubramanian D, Iyer S. Volume and location of the defect as predictors of speech outcome after glossectomy: correlation with a classification. Int J Oral Maxillofac Surg 2021; 50:1533-1539. [PMID: 33714613 DOI: 10.1016/j.ijom.2021.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/17/2020] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Abstract
The evaluation of speech outcomes after resection and reconstruction of the oral tongue remains largely unsystematic. A cross-sectional study was performed to analyse the speech outcomes of patients who underwent curative treatment with appropriate reconstruction. Sixty-nine patients were assessed for speech intelligibility and phonetics using a validated speech intelligibility assessment tool in the local language. Volume defects were classified as class I (less than one third), II (one third to half), III (half to two-thirds), or IV (two-thirds to total glossectomy). Defect location was defined as lateral, tip, or sulcus. The χ2 test and Kruskal-Wallis test were used to test volume and location as predictors. Twenty-six patients had class I defects, 29 had class II defects, seven had class III defects, and seven had class IV defects. Twenty-two patients (31.9%) received adjuvant radiotherapy. Mean vowel, consonant, word, and paragraph intelligibility were 99.27%, 86.86%, 85.52%, and 88.72%, respectively. The incremental volume of the glossectomy defect was significantly correlated with speech intelligibility scores and phonatory alterations. In classes II and III, tip resection significantly affected interdental sounds. All patients in class III had affected alveolar and alveo-palatal sounds. The results positively corroborated the volume and location of the glossectomy defect to a classification system.
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Affiliation(s)
- S Bhattacharya
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - K Thankappan
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
| | - S V Sukumaran
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - M Mayadevi
- Division of Swallowing Therapy, Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - D Balasubramanian
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - S Iyer
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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De Santis G, Mattioli F, Pinelli M, Martone A, Starnoni M, Fermi M, Presutti L. Tip of the Tongue Reconstruction with Prelaminated Fasciomucosal Radial Forearm Free Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3226. [PMID: 33425574 PMCID: PMC7787281 DOI: 10.1097/gox.0000000000003226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Abstract
Tongue cancer is the most common malignant neoplasm of the oral cavity. Occurrence in the tip of the tongue (TOT) is rare. We describe a case report of a TOT tumor excision and reconstruction with a prelaminated fasciomucosal radial forearm free flap. A 41-year-old white man was referred to our department for a squamous cell carcinoma of the tip of the tongue. The patient worked as an air traffic control official; therefore, conservation of speech intelligibility, both in Italian and English language, was of paramount importance. A transoral excision of TOT, bilateral selective neck dissection, and reconstruction with prelaminated fasciomucosal radial forearm free flap were performed. Adjuvant radiotherapy was necessary. The patient was completely re-established as an air traffic control officer. Successful tongue reconstruction of smaller defects depends on thinness, pliability of flap, and conservation of tongue mobility. Surgical options for TOT reconstruction are facial artery muscolomucosa flap, Zhao flap, radial forearm free flap, or primary suture. In the authors' opinion, a fasciomucosal prelaminated RFFF offers a series of advantages for TOT reconstruction. The absence of subcutaneous tissue makes the PFRFFF much thinner than fascio-cutaneous flaps. Compared with mucosal loco-regional flaps, prelaminated flaps allow the preservation of oral mucosa lining while providing adequate bulk and reduced scar formation for optimal func- tional recovery. In our case report, the fasciomucosal flap allowed an adequate reconstruction of TOT volume with good functional and aesthetic outcomes. The flap's added bulk and its minimal scar retraction granted free tongue movement and optimal speech intelligibility.
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Affiliation(s)
- Giorgio De Santis
- From the Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
| | - Francesco Mattioli
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
| | - Massimo Pinelli
- From the Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
| | - Andrea Martone
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
| | - Marta Starnoni
- From the Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
| | - Matteo Fermi
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy
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Lu J, Chen Y, Xia RH, Shen Y, Zheng Z, Sun J. Modification of the anterior-posterior tongue rotation flap for oral tongue reconstruction. Head Neck 2020; 42:3769-3775. [PMID: 32767540 DOI: 10.1002/hed.26409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/05/2020] [Accepted: 07/20/2020] [Indexed: 11/11/2022] Open
Abstract
The aim of this study is to evaluate the efficacy and long-term outcome of a modification of the anterior-posterior tongue rotation flap used for reconstruction of tongue following cancer ablation. From April 2016 to September 2017, 21 consecutive patients with tumor classification (T2), lymph node classification (N0) tongue cancer on the anterior and middle one-third portion were selected for this study. A modification of the anterior-posterior tongue rotation flap was selected for tongue reconstruction after the cancer resection. Patient's scorings of swallowing, chewing, speech and taste were recorded. Patient after tongue flap reconstruction acquired satisfied tongue movement that allows normal functional outcomes for swallowing, chewing, speech and taste. Local tumor recurrence was not observed during the follow-up examination (range, 12-24 months). The modification of the anterior-posterior tongue rotation flap was a safe and reliable treatment for medium-size tongue cancer (T2N0), especially suitable to patients who cannot endure prolonged surgery.
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Affiliation(s)
- Junqin Lu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yahong Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong-Hui Xia
- Department of Oral Pathology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yi Shen
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhiwei Zheng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jian Sun
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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12
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Mäkitie A, Kamali A, Mroueh R, Lindford A, Koivunen P, Autio T, Lassus P, Halle M, Bäck L, Palmgren B, Hammarstedt-Nordenvall L. A descriptive study highlighting the differences in the treatment protocol for oral tongue cancer in Sweden and Finland. Acta Otolaryngol 2020; 140:188-194. [PMID: 31852347 DOI: 10.1080/00016489.2019.1699663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and aims: Stage II cancer of the tongue is mostly managed surgically both locally and regionally. However, indications for postoperative radiotherapy and reconstructive options vary between centers. This paper aims to describe differences in treatment in a geographically homogenous cohort.Methods: A retrospective comparison was made between two cohorts of clinical T2N0 tongue cancer from Finland and Sweden. The Finnish cohort included 75 patients and the Swedish 54. All patients had curative intent of treatment and no previous head and neck cancer. Data analyzed consisted of pathological stage, size and thickness of tumor, frequency of reconstruction, radiotherapy delivered, and survival.Results: The Finnish cohort included a higher proportion of patients managed with reconstructive surgery (67%) than the Swedish cohort (0%), p < .00001. More patients were treated with postoperative radiotherapy (84%) in the Swedish cohort than in the Finnish (54%), p < .0002. The Finnish cohort had a higher level of survival and included more frequent downstaging (cTNM to pTNM).Conclusions and significance: Our data indicate a major difference in the management of T2N0 oral tongue cancer. The optimal cut-off size and growth pattern of the tumor warranting reconstruction should be further evaluated in a prospective manner considering both survival and quality of life.
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Affiliation(s)
- Antti Mäkitie
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Kamali
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Rayan Mroueh
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Andrew Lindford
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petri Koivunen
- Department of Otorhinolaryngology – Head and Neck Surgery, Oulu University Hospital, Oulu, Finland
| | - Timo Autio
- Department of Otorhinolaryngology – Head and Neck Surgery, Oulu University Hospital, Oulu, Finland
| | - Patrik Lassus
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Martin Halle
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Leif Bäck
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Björn Palmgren
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lalle Hammarstedt-Nordenvall
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Beavertail modification of the radial forearm free flap in total oral glossectomy reconstruction: Technique and functional outcomes. Oral Oncol 2019; 96:71-76. [DOI: 10.1016/j.oraloncology.2019.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [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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Liu CJ, Fang KH, Chang CC, Lin ET, Chang GH, Shen JH, Chen YT, Tsai YT. Application of "parachute" technique for free flap reconstruction in advanced tongue cancer after ablation without lip-jaw splitting: A retrospective case study. Medicine (Baltimore) 2019; 98:e16728. [PMID: 31415367 PMCID: PMC6831483 DOI: 10.1097/md.0000000000016728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The hemi or subtotal/total glossectomy is usually approached by lip-jaw splitting procedure for advanced tongue cancer ablation. This highly invasive procedure can cause facial disfiguration, bone malunion, and osteoradionecrosis. The aim of this study is to compare the surgical outcome in free flap tongue reconstruction between novel parachute technique in an intact jaw and the conventional lip-jaw splitting procedure after tongue cancer ablation.In this study, parachute technique was adopted for free flap inset in patients without mandibulotomy. We retrospectively reviewed patients who have received primary advanced tongue cancer resection and free flap reconstruction during April, 2008 to January, 2015. Patients were divided into 2 groups. Group A was undergoing parachute technique without lip-jaw splitting. We sutured all the strings through the edges of defect in the first step and through the matching points of flap margin in the second step from outside the oral cavity. Then, the strings were pulled and the flap was parachuted down on the defects after all the matching points were tied together. In group B, the patients received conventional lip-jaw splitting procedure. Student t test was used for results analysis.There were 15 patients (n = 15) in group A and 15 patients (n = 15) in group B. In the patients receiving parachute technique, operation time showed 34 minutes (P = .49) shorter, hospital stay showed 4 days (P = .32) shorter, and the infection rate of surgical site showed 6.6% (P = .64) less than with conventional technique. The survival rates of the flaps were both 100% without revision.The parachute technique is an effective and more accessible method for free flap setting in cases of tongue reconstruction without lip-jaw splitting, and provides patients with better aesthetic appearance.
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Affiliation(s)
- Chin-Jui Liu
- Department of Otolaryngology, An-Nan Hospital, China Medical University, Tainan
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Ku-Hao Fang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan
| | - Chang-Cheng Chang
- School of Medicine, College of Medicine, China Medical University
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung
| | - Erh-Ti Lin
- School of Medicine, College of Medicine, China Medical University
| | - Geng-He Chang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Jen-Hsiang Shen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan
| | - Yu-Tsung Chen
- Department of Dermatology, Shuang Ho Hospital, Taipei, Taiwan (R.O.C.)
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi
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Wang Y, Yang X, Gan R, Liu H, Wu G, Yu Q, Wang Z, Lu X, Jing J, Ma W, Quan Y, Sun Z, Fan L, Wang Y. Digital planning workflow for partial maxillectomy using an osteotomy template and immediate rehabilitation of maxillary Brown II defects with prosthesis. J Oral Rehabil 2019; 46:1133-1141. [PMID: 31260120 DOI: 10.1111/joor.12850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is increasing evidence of benefits for the rehabilitation of Brown II defects with prosthesis in surgery. However, the current literature is sparse for maxillary tumour resection using osteotomy templates. OBJECTIVES To assess the accuracy of maxillectomy using a custom fabricated osteotomy template and to evaluate the prosthesis for surgical accuracy, appearance and functioning (speech, swallowing and occlusal force). METHODS Ten patients with Brown II defects caused by tumour resection were treated with precise partial maxillectomy using an osteotomy template. The immediate rehabilitation of the Brown II defect was completed with a prefabricated prosthesis. The post-operative three-dimensional images and the pre-operative virtual images were superimposed, and average deviation and maximum deviation were calculated. Speech intelligibility, swallowing, appearance and University of Washington Quality of Life Questionnaire (UW-QoL) were examined at 1, 3 and 6 months after surgery. Occlusal force was examined post-operatively at 6 months. RESULTS The maximum deviation between the actual and virtual surgery was 5.12 ± 0.44 mm, with an average of 1.02 ± 0.17 mm. Speech intelligibility, swallowing and UW-QoL improved significantly (P < .05) after wearing the prosthesis. The recovery index of the occlusal force on the affected side was 20.19%-32.28%. The skewed degree of the mouth corner, the difference in the height of the left and right lips, the maximum deviation distance and the change area volume decreased significantly (P < .05). CONCLUSION The precise rehabilitation of maxillary Brown II defects can be achieved using a prosthesis fabricated with an osteotomy template. The prosthesis restored appearance and functional capabilities (such as speech and occlusal force).
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Affiliation(s)
- Yang Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xudong Yang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ronglin Gan
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Huifen Liu
- Department of Oral Implantology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guofeng Wu
- Department of Oral Prosthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qing Yu
- Department of Oral Prosthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhiyong Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaolin Lu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jianlong Jing
- Department of Oral Prosthodontics Technician, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenjie Ma
- Department of Oral Implantology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yi Quan
- Shanghai UEG Medical Device Co., Ltd, Shanghai, China
| | - Ziang Sun
- Shanghai UEG Medical Device Co., Ltd, Shanghai, China
| | - Lei Fan
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuxin Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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Tawa P, Foirest C, Tankéré F, Ouar N, Brault N, Atlan M, Qassemyar Q. [Tongue reconstruction by thoracodorsal perforator flap: A new harvesting technique to reduce morbidity]. ANN CHIR PLAST ESTH 2019; 64:368-373. [PMID: 30827573 DOI: 10.1016/j.anplas.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
The thoracodorsal artery perforator flap is increasingly used in head and neck reconstructions. One of its multiple advantages is the low donor site morbidity compared to the other free flaps usually used for this type of surgery, such as the radial forearm free flap and the anterolateral flap of the thigh. However, the current harvesting technique of the thoracodorsal artery free perforator flap needs a vertical incision rising high in the axillary hollow for the dissection of the pedicle, thus impeding optimal discretion of the donor site, especially for women. We describe an original technique to harvest a pure transversal skin paddle on its own perforator, leaving a horizontal scar thoroughly hidden in the bra and preserving the thoracodorsal pedicle. We detail the requirements for this new type of harvesting.
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Affiliation(s)
- P Tawa
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de chirurgie plastique, reconstructrice et brûlés, hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France
| | - C Foirest
- Service d'oto-rhino-laryngologie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - F Tankéré
- Service d'oto-rhino-laryngologie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - N Ouar
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - N Brault
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - M Atlan
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - Q Qassemyar
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France; Service de chirurgie plastique, reconstructrice et brûlés, hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France.
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Stelzle F, Oetter N, Goellner LT, Adler W, Rohde M, Maier A, Matthies L, Kesting MR, Knipfer C. Speech intelligibility in patients with oral cancer: An objective baseline evaluation of pretreatment function and impairment. Head Neck 2019; 41:1063-1069. [PMID: 30801814 DOI: 10.1002/hed.25527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 08/07/2018] [Accepted: 10/06/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This study seeks to identify those factors that influence the pre-therapeutic speech intelligibility in patients with oral squamous cell carcinoma (OSCC). METHOD A group of 172 patients (125 males, 47 females, mean age = 61 ± 11 a) with different OSCC stages ranging from T1 to T4 and N0 to N2 was examined for their speech intelligibility using a computerized measuring tool, and compared to a healthy reference group (30 males, 10 females, mean age = 59 ± 12 a). RESULTS It was found that the pre-therapeutic speech intelligibility in patients with OSCC is decreased when compared to a healthy collective. Two demographic factors that influence speech intelligibility could be identified: sex and age. It was determined that the only disease-related factor that influences speech intelligibility before therapy is the location of the tumor. CONCLUSION The results of this study reveal that a preoperative speech intelligibility impairment in patients suffering from OSCC occurs independent of tumor stage, size of the tumor and infiltration status.
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Affiliation(s)
- Florian Stelzle
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Nicolai Oetter
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Luisa Theresa Goellner
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology (IMBE), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Maximilian Rohde
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilian-University Munich, University Hospital Munich, Munich, Germany
| | - Andreas Maier
- Department of Computer Science 5, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Levi Matthies
- Department of Oral and Maxillofacial Surgery, University of Hamburg (UHH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Rainer Kesting
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Christian Knipfer
- Department of Oral and Maxillofacial Surgery, University of Hamburg (UHH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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19
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Long-term quality of life measured by the University of Washington QoL questionnaire (version 4) in patients with oral cancer treated with or without reconstruction with a microvascular free flap. Br J Oral Maxillofac Surg 2018; 56:475-481. [DOI: 10.1016/j.bjoms.2017.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 12/29/2017] [Indexed: 12/17/2022]
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20
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Nguyen KA, Bui TX, Van Nguyen H, Wein RO. Progressive functional improvement in hemiglossectomy defects reconstructed with radial forearm free flap at 6-months. Am J Otolaryngol 2018; 39:317-320. [PMID: 29544671 DOI: 10.1016/j.amjoto.2018.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/06/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purposes of the study was to evaluate for the functional improvement of outcomes of patients undergoing surgical management for tongue cancer at varying periods after surgery. DESIGN Case series with intervention. PARTICIPANTS Thirty consecutive patients, from 2011 to 2015, with carcinoma of the tongue undergoing surgical resection and reconstruction with a radial forearm free flap. MAIN MEASURES The Speech Intelligibility Test (SIT) is used for objective evaluation of speech function. The 7-point ordinal scale Functional Oral Intake Score (FOIS) was used to estimate the swallowing function. RESULTS The patients included were 25 men and 5 women with a mean age of 50.4 years (range - 27-65). All tumors were squamous cell carcinomas and all patients underwent a hemiglossectomy. There were two complete flap failures, with a resultant flap success rate of 93.3%. The initial mean speech intelligibility scores at 1-month increased from 72.3 ± 0.2 to 77.7 ± 8.9 at 6-months after surgery (p = 0.05). Similarly, the mean score of swallowing function improved from 6.1 at 1-month to 6.8 at 6-months after surgery (p = 0.05). CONCLUSION Reconstruction of hemiglossectomy defects with a radial forearm free flap offers functional benefits in speech and deglutition that demonstrate progressive improvement when 1- and 6-month post-surgical assessments are compared.
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Affiliation(s)
| | | | - Hue Van Nguyen
- Faculty of Social Sciences and Humanities, Ton Duc Thang University, Viet Nam
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21
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Ji YB, Cho YH, Song CM, Kim YH, Kim JT, Ahn HC, Tae K. Long-term functional outcomes after resection of tongue cancer: determining the optimal reconstruction method. Eur Arch Otorhinolaryngol 2017; 274:3751-3756. [DOI: 10.1007/s00405-017-4683-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
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22
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Khan MN, Perez E, Goljo E, Iloreta A, Park RCW, Genden EM, Miles BA. The price of free tissue transfer after tongue reconstruction: quantifying the risks. Laryngoscope 2017; 127:1551-1557. [DOI: 10.1002/lary.26461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/01/2016] [Accepted: 11/14/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Mohemmed N. Khan
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
| | - Enrique Perez
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
| | - Erden Goljo
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
| | - Alfred Iloreta
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
| | - Eric M. Genden
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
- Department of Otolaryngology-Head and Neck Surgery; Rutgers University; Newark New Jersey U.S.A
| | - Brett A. Miles
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
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Ha J, Sung IY, Son JH, Stone M, Ord R, Cho YC. Analysis of speech and tongue motion in normal and post-glossectomy speaker using cine MRI. J Appl Oral Sci 2016; 24:472-480. [PMID: 27812617 PMCID: PMC5083024 DOI: 10.1590/1678-775720150421] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 06/16/2016] [Indexed: 12/03/2022] Open
Abstract
Objective Since the tongue is the oral structure responsible for mastication, pronunciation, and swallowing functions, patients who undergo glossectomy can be affected in various aspects of these functions. The vowel /i/ uses the tongue shape, whereas /u/ uses tongue and lip shapes. The purpose of this study is to investigate the morphological changes of the tongue and the adaptation of pronunciation using cine MRI for speech of patients who undergo glossectomy. Material and Methods Twenty-three controls (11 males and 12 females) and 13 patients (eight males and five females) volunteered to participate in the experiment. The patients underwent glossectomy surgery for T1 or T2 lateral lingual tumors. The speech tasks “a souk” and “a geese” were spoken by all subjects providing data for the vowels /u/ and /i/. Cine MRI and speech acoustics were recorded and measured to compare the changes in the tongue with vowel acoustics after surgery. 2D measurements were made of the interlip distance, tongue-palate distance, tongue position (anterior-posterior and superior-inferior), tongue height on the left and right sides, and pharynx size. Vowel formants Fl, F2, and F3 were measured. Results The patients had significantly lower F2/Fl ratios (F=5.911, p=0.018), and lower F3/F1 ratios that approached significance. This was seen primarily in the /u/ data. Patients had flatter tongue shapes than controls with a greater effect seen in /u/ than /i/. Conclusion The patients showed complex adaptation motion in order to preserve the acoustic integrity of the vowels, and the tongue modified cavity size relationships to maintain the value of the formant frequencies.
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Affiliation(s)
- Jinhee Ha
- University of Ulsan, Ulsan University Hospital, College of Medicine, Department of Dentistry, Ulsan, South Korea
| | - Iel-Yong Sung
- University of Ulsan, Ulsan University Hospital, College of Medicine, Department of Oral and Maxillofacial Surgery, Ulsan, South Korea
| | - Jang-Ho Son
- University of Ulsan, Ulsan University Hospital, College of Medicine, Department of Oral and Maxillofacial Surgery, Ulsan, South Korea
| | - Maureen Stone
- University of Maryland, Department of Oral and Craniofacial Biological Science, Baltimore, United States of America
| | - Robert Ord
- University of Maryland, Department of Oral and Maxillofacial Surgery, Baltimore, United States of America
| | - Yeong-Cheol Cho
- University of Ulsan, Ulsan University Hospital, College of Medicine, Department of Oral and Maxillofacial Surgery, Ulsan, South Korea
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Phonologic and Acoustic Analysis of Speech Following Glossectomy and the Effect of Rehabilitation on Speech Outcomes. J Oral Maxillofac Surg 2016; 75:1530-1541. [PMID: 28039737 DOI: 10.1016/j.joms.2016.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/01/2016] [Accepted: 12/01/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Changes in acoustic features in the perioperative phase for elucidating the mechanisms of articulation disorder and the effect of perioperative rehabilitation were studied prospectively. MATERIALS AND METHODS Sixty-two patients with 62 tongue cancer were divided into a partial glossectomy group (n = 40) and a reconstruction group (n = 22). Acoustic characteristics were analyzed during the preoperative and postoperative periods and after rehabilitation using the first and second formants of the vowels /a/, /i/, and /u/; the triangular vowel space area (tVSA); and the slopes of formant transitions. RESULTS In the 2 groups, decreases in the tVSA and formant slopes were found from the preoperative to the postoperative period, and the acoustic characteristics of the reconstruction group especially improved to preoperative values after rehabilitation. Analysis of the postoperative period showed that acoustic characteristics were altered at the site of surgical resection. CONCLUSION Changes of acoustic variables are related to excision size and site, suggesting the distinctive tongue portion for the articulation of each speech sound. Perioperative rehabilitation could activate the articulators and increase the range of movement of the remaining tongue, especially the preserved anterior tongue.
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Riemann M, Knipfer C, Rohde M, Adler W, Schuster M, Noeth E, Oetter N, Shams N, Neukam FW, Stelzle F. Oral squamous cell carcinoma of the tongue: Prospective and objective speech evaluation of patients undergoing surgical therapy. Head Neck 2015; 38:993-1001. [DOI: 10.1002/hed.23994] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 12/29/2022] Open
Affiliation(s)
- Max Riemann
- Department of Oral and Maxillofacial Surgery; University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU); Erlangen Germany
| | - Christian Knipfer
- Department of Oral and Maxillofacial Surgery; University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU); Erlangen Germany
| | - Maximilian Rohde
- Department of Oral and Maxillofacial Surgery; University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU); Erlangen Germany
| | - Werner Adler
- Department of Medical Informatics; Biometry and Epidemiology; Friedrich-Alexander University Erlangen-Nuremberg (FAU); Erlangen Germany
| | - Maria Schuster
- Department of Otolaryngology; University Hospital of Munich, Ludwig-Maximilians University Munich (LMU); Munich Germany
| | - Elmar Noeth
- Department of Computer Science; Chair of Pattern Recognition; Friedrich-Alexander University Erlangen-Nuremberg (FAU); Erlangen Germany
| | - Nico Oetter
- Department of Oral and Maxillofacial Surgery; University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU); Erlangen Germany
| | - Nima Shams
- Department of Oral and Maxillofacial Surgery; University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU); Erlangen Germany
| | - Friedrich-Wilhelm Neukam
- Department of Oral and Maxillofacial Surgery; University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU); Erlangen Germany
| | - Florian Stelzle
- Department of Oral and Maxillofacial Surgery; University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU); Erlangen Germany
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26
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Principles and Practice of Reconstructive Surgery for Head and Neck Cancer. Surg Oncol Clin N Am 2015; 24:473-89. [DOI: 10.1016/j.soc.2015.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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27
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Jeong WH, Lee WJ, Roh TS, Lew DH, Yun IS. Long-term functional outcomes after total tongue reconstruction: Consideration of flap types, volume, and functional results. Microsurgery 2015; 37:190-196. [DOI: 10.1002/micr.22440] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 05/31/2015] [Accepted: 06/03/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Woon Hyeok Jeong
- Department of Plastic and Reconstructive Surgery; Keimyung University School of Medicine, Dongsan Medical Center; Daegu Korea
| | - Won Jai Lee
- Department of Plastic and Reconstructive Surgery; Institute for Human Tissue Restoration, Yonsei University Health System, Severance Hospital; Seoul Korea
| | - Tai Suk Roh
- Department of Plastic and Reconstructive Surgery; Institute for Human Tissue Restoration, Yonsei University Health System, Gangnam Severance Hospital; Seoul Korea
| | - Dae Hyun Lew
- Department of Plastic and Reconstructive Surgery; Institute for Human Tissue Restoration, Yonsei University Health System, Severance Hospital; Seoul Korea
| | - In Sik Yun
- Department of Plastic and Reconstructive Surgery; Institute for Human Tissue Restoration, Yonsei University Health System, Gangnam Severance Hospital; Seoul Korea
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Chang EI, Yu P, Skoracki RJ, Liu J, Hanasono MM. Comprehensive analysis of functional outcomes and survival after microvascular reconstruction of glossectomy defects. Ann Surg Oncol 2015; 22:3061-9. [PMID: 25634781 DOI: 10.1245/s10434-015-4386-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Few studies on tongue reconstruction provide a comprehensive, multidisciplinary analysis examining defect size, flap selection, function, and long-term survival. This report presents the largest study in the literature evaluating free flap reconstruction after glossectomy. METHODS A retrospective review of patients undergoing free flap glossectomy reconstruction from 2000 to 2012 was performed. RESULTS In this review, 268 patients were identified. Resections involving the tongue only included 59 partial glossectomies, 86 hemiglossectomies, 28 subtotal glossectomies, and 24 total glossectomies. Glossectomies performed with mandibulectomies were analyzed independently for speech and swallowing function (32 partial glossectomies, 18 hemiglossectomies, 8 subtotal glossectomies, and 13 total glossectomies with mandibulectomy). A total of 299 free flaps were performed, with 30 patients receiving two free flaps. Multivariate analysis demonstrating smoking (p = 0.018), composite resections (p < 0.001), and larger resections (total and subtotal glossectomies; p < 0.001) were associated with significantly worse speech results. Advanced age (p = 0.002), radiation (p = 0.003), and larger or composite resections had significantly worse swallowing function (p < 0.001). Patients with a persistent tracheostomy had significantly worse speech and swallowing function (p < 0.001), whereas innervated flaps were associated with superior speech (p = 0.049) and better swallowing function (p = 0.004). The surgical complication rate was 23.5 %, with only one total flap loss. Tumor stage (p = 0.003), positive margins (p < 0.001), lymphovascular invasion (p = 0.023), and chemotherapy (p < 0.001) were associated with significantly worse overall survival. The median overall survival time was 50.5 months (range 39-79 months). CONCLUSIONS Although comorbidities and the extent of resection impair both speech and swallowing, reconstruction, particularly with innervated free flaps, still affords the majority of patients' reasonable function.
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Affiliation(s)
- Edward I Chang
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
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Lee DY, Ryu YJ, Hah JH, Kwon TK, Sung MW, Kim KH. Long-term subjective tongue function after partial glossectomy. J Oral Rehabil 2014; 41:754-8. [DOI: 10.1111/joor.12193] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- D. Y. Lee
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Y.-J. Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
| | - J. H. Hah
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
| | - T.-K. Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
| | - M.-W. Sung
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
| | - K. H. Kim
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
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Factors influencing relative speech intelligibility in patients with oral squamous cell carcinoma: a prospective study using automatic, computer-based speech analysis. Int J Oral Maxillofac Surg 2013; 42:1377-84. [DOI: 10.1016/j.ijom.2013.05.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 05/27/2013] [Accepted: 05/30/2013] [Indexed: 11/24/2022]
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Speech and swallowing following tongue cancer surgery and free flap reconstruction – A systematic review. Oral Oncol 2013; 49:507-24. [DOI: 10.1016/j.oraloncology.2013.03.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 02/04/2013] [Accepted: 03/04/2013] [Indexed: 11/20/2022]
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Boyapati RP, Shah KC, Flood V, Stassen LFA. Quality of life outcome measures using UW-QOL questionnaire v4 in early oral cancer/squamous cell cancer resections of the tongue and floor of mouth with reconstruction solely using local methods. Br J Oral Maxillofac Surg 2012; 51:502-7. [PMID: 23068128 DOI: 10.1016/j.bjoms.2012.09.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 09/18/2012] [Indexed: 11/15/2022]
Abstract
Cancer treatment either by surgery alone or in a combination of surgery, radiotherapy±chemotherapy has significant consequences on the physical, mental, emotional and psychosocial wellbeing of the patient. Measurement of quality of life (QOL) is necessary to understand the patient's perception of their own treatment, as clinicians' views can be biased. Reconstruction of a cancerous defect with a free vascular flap is ideal in large, often composite defects, provided it is appropriate to the advanced stage and prognosis of the disease, medical condition of the patient, availability of surgical and financial resources and allows the prosthetic rehabilitation of the anatomic area. Using University of Washington Quality of life 4 questionnaire (UW-QOL4), we assessed the QOL of 38 patients, who underwent local surgical reconstructions after resection of T1/T2 tongue/floor of mouth squamous cell carcinoma defects. Objective assessment of speech and swallow function was also carried out using therapy outcome measure (TOM) scores by the speech and language therapy team (SALT) aiming to see the differences in the scores obtained in patients who underwent post-operative radiotherapy. Our study, conducted 6months after completion of all oncologic treatment for the primary disease, showed satisfactory levels of quality of life parameters with good function showing that local reconstructive methods are successful and may have benefits in the management of early oral cancers involving the tongue and floor of mouth. They are beneficial by providing a good quality in terms of function, by reducing the operating time, the surgical morbidity, simplifying post-operative care and thereby becoming an efficient, effective and a cost effective method.
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Affiliation(s)
- Raghuram P Boyapati
- National Maxillofacial unit, St James's Hospital, James's Street, Dublin, Ireland.
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Dziegielewski PT, Ho ML, Rieger J, Singh P, Langille M, Harris JR, Seikaly H. Total glossectomy with laryngeal preservation and free flap reconstruction: objective functional outcomes and systematic review of the literature. Laryngoscope 2012; 123:140-5. [PMID: 22952109 DOI: 10.1002/lary.23505] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2012] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Advanced tongue cancer is a devastating diagnosis with potential for significant morbidity after treatment. This is especially true for patients undergoing total glossectomy with laryngeal preservation (TGLP), free flap reconstruction and adjuvant radiotherapy. The goals of this study were to: 1) determine long-term objective functional and quality of life outcomes, 2) investigate the influence of rehabilitation on functional recovery and 3) determine swallowing ability in patients with TGLP. STUDY DESIGN Prospective cohort study and systematic review of the literature. METHODS Functional outcomes data were collected from 2000-2010. Outcomes were measured pre- and 12 months post-surgery and included: gastrostomy-tube (G-Tube) rates, swallowing transit times on video fluoroscopic swallowing studies, speech intelligibility and EORTC-H&N 35 quality of life scores. A systematic review of the literature was conducted to determine comprehensive long term G-Tube rates. RESULTS Twelve patients were included and eight were still living at 12 months post-surgery. Fifty percent of patients in this study and 24% with systematic review used G-Tubes at 1 year post-surgery. Patients who could swallow did not aspirate, but more than doubled swallowing transit times. Spoken sentence intelligibility averaged 66% and mean quality of life scores improved 8.9 points 12 months post-surgery. Patients who attended >80% of swallowing and speech rehabilitation sessions demonstrated superior swallowing and speech functional outcomes. CONCLUSIONS Although a potentially morbid treatment, TGLP and free flap reconstruction can provide good swallowing and speech outcomes as well as meaningful long-term quality of life. Regular attendance of rehabilitation sessions is imperative to optimize functional outcomes.
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Affiliation(s)
- Peter T Dziegielewski
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada
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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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Stelzle F, Maier A, Nöth E, Bocklet T, Knipfer C, Schuster M, Neukam FW, Nkenke E. Automatic Quantification of Speech Intelligibility in Patients After Treatment for Oral Squamous Cell Carcinoma. J Oral Maxillofac Surg 2011; 69:1493-500. [DOI: 10.1016/j.joms.2010.05.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 02/28/2010] [Accepted: 05/17/2010] [Indexed: 10/18/2022]
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Laaksonen JP, Rieger J, Happonen RP, Harris J, Seikaly H. Speech after radial forearm free flap reconstruction of the tongue: a longitudinal acoustic study of vowel and diphthong sounds. CLINICAL LINGUISTICS & PHONETICS 2010; 24:41-54. [PMID: 20030552 DOI: 10.3109/02699200903340758] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The purpose of this study was to use acoustic analyses to describe speech outcomes over the course of 1 year after radial forearm free flap (RFFF) reconstruction of the tongue. Eighteen Canadian English-speaking females and males with reconstruction for oral cancer had speech samples recorded (pre-operative, and 1 month, 6 months, and 1 year post-operative). Acoustic characteristics of formants (F1, F2), fundamental frequency (F0), and duration of 699 vowel and diphthong tokens were analysed. Furthermore, the changes in size of the vowel space area were studied, as well as the effects of radiation therapy (RT) and inclusion of the floor of the mouth (FOM) in the reconstruction. RFFF reconstruction was found to affect several characteristics in males, and a minimal number of variables in females. General signs of reduced ability to articulate were not observed. RT and FOM had no differing effects compared to non-RT or non-FOM. There were individual differences between patients.
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Affiliation(s)
- Juha-Pertti Laaksonen
- Department of Speech Pathology and Audiology, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
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Dwivedi RC, Kazi RA, Agrawal N, Nutting CM, Clarke PM, Kerawala CJ, Rhys-Evans PH, Harrington KJ. Evaluation of speech outcomes following treatment of oral and oropharyngeal cancers. Cancer Treat Rev 2009; 35:417-24. [DOI: 10.1016/j.ctrv.2009.04.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 04/26/2009] [Indexed: 10/20/2022]
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Kelly P, Drago CJ. Surgical and prosthodontic treatment of a patient with significant trauma to the middle and lower face secondary to a gunshot wound: a clinical report. J Prosthodont 2009; 18:626-37. [PMID: 19515164 DOI: 10.1111/j.1532-849x.2009.00483.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Large defects of dentofacial structures may result from trauma, disease (including neoplasms), and congenital anomalies. The location and size of the defects are related to difficulties that patients report relative to speech, mastication, swallowing, facial esthetics, and self-image. This article reports on the evaluation and treatment of a patient who suffered significant trauma to the lower and mid-face secondary to a gunshot injury. It describes the initial presentation, life-saving procedures, and subsequent bone grafts, implant placement, and prosthetic treatments required to rehabilitate the patient to a condition that closely approximated his preoperative condition. This clinical report confirms that no matter the degree of complexity involved in treating the results of significant facial trauma, successful treatment is dependent on thorough physical and radiographic examinations, development of the appropriate diagnoses, and treatment based on sound prosthodontic and surgical principles.
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Affiliation(s)
- Paul Kelly
- Arizona Maxillofacial Surgeons PC, Mesa, AZ, USA
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