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Morita T, Sasaki T, Koizumi Y, Fukushima H, Shimbashi W, Mitani H. Favourable swallowing outcomes after subtotal glossectomy with laryngeal suspension. Int J Oral Maxillofac Surg 2024; 53:191-198. [PMID: 37516548 DOI: 10.1016/j.ijom.2023.07.002] [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: 01/05/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
Subtotal or total glossectomy for advanced tongue cancer has an adverse impact on swallowing. The purpose of this retrospective study was to analyse postoperative swallowing outcomes and to determine the ideal reconstruction method in these patients. The clinical and swallowing data of patients with tongue cancer who underwent subtotal glossectomy at the study institution between 2005 and 2019 were reviewed retrospectively. Data were available for 101 patients. The most common reconstruction method was a free rectus abdominis musculocutaneous flap (69 cases). The postoperative feeding tube dependency rate was 11.1% at discharge and 9.4% at 1 year. During the study period, laryngeal suspension and/or a cricopharyngeal myotomy was performed in 39 patients (38.6%), with 25 of these operations performed after 2017. Patients treated in 2017-2019 were significantly more able to take thin liquid (P < 0.001) and lost less weight (P = 0.015) compared to those treated in 2005-2016. Multivariate analysis of 61 patients who did not undergo laryngeal suspension and/or cricopharyngeal myotomy showed significant feeding tube dependency in those aged 65 years and older (P = 0.004). Thin liquid intake was significantly improved after subtotal glossectomy with laryngeal suspension, which led to better postoperative swallowing and improved quality of life.
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Affiliation(s)
- T Morita
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - T Sasaki
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Koizumi
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - H Fukushima
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - W Shimbashi
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - H Mitani
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Huang CC, Yang TL, Tseng WH, Lee TC, Ko JY. An alternative surgical technique for advanced tongue/tongue base cancer without free flap reconstruction. J Formos Med Assoc 2022; 121:2626-2632. [PMID: 35985885 DOI: 10.1016/j.jfma.2022.07.007] [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: 06/21/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/PURPOSE Locally advanced tongue or tongue base cancer is recommended to be treated by radical resection that is usually detrimental to physiological functions. This study reports the efficacy and treatment outcome of the patients who had received total glossectomy and laryngeal suspension without lip-split mandibulotomy and free flap reconstruction to preserve laryngopharyngeal function. METHODS From 2010 to 2018, 37 consecutive patients who had received the surgery were retrospectively recruited. RESULTS The overall five-year survival is 72%. The postoperative dependent rate of feeding tube and tracheostomy largely decreases within 1-year follow-up. Treated by this surgical method, these patients are free from facial disfiguration, donor site morbidity, and destructive mastication and occlusion. It is also feasible to perform this surgical technique in the recurrent cases previously treated by chemoradiation. CONCLUSION Total glossectomy with laryngeal suspension can be successfully applied to locally advanced tongue or tongue base cancer, and benefits the patients with improved survival and preserved physiological function. Especially surgeons for free flap reconstruction are understaffed at some regional or district hospitals.
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Affiliation(s)
- Chun-Chi Huang
- Department of Otolaryngology, Lotung Pohai Hospital, Yilan, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Hsuan Tseng
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzu Chiang Lee
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, Lotung Pohai Hospital, Yilan, Taiwan; Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Outcome Evaluation of Mandibular Pull-Through Approach for Glossectomies. Indian J Surg Oncol 2021; 12:722-728. [DOI: 10.1007/s13193-021-01417-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 08/09/2021] [Indexed: 11/25/2022] Open
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Nemade H, Chaitanya S A, Kumar S, A AK, Rao TS, Rao S LMCS. Oncological outcomes of total glossectomy procedure for advanced tongue cancer: a single-centre experience. Int J Oral Maxillofac Surg 2021; 51:152-158. [PMID: 34016519 DOI: 10.1016/j.ijom.2021.04.006] [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: 01/15/2021] [Revised: 02/18/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022]
Abstract
Surgeons treating advanced carcinoma of the tongue with total glossectomy face many conflicts in view of the morbidity and poor functional and survival outcomes following surgery. It is pertinent to study the patients undergoing total tongue compartment resection as a separate cohort to analyse their outcomes. This study investigated the oncological outcomes of 150 patients with advanced tongue squamous cell carcinoma who underwent total glossectomy. The results suggest that compartment resection significantly improved local control, irrespective of margin status. The presence of multiple positive nodes was found to be an independent poor prognostic factor, and adjuvant radiation significantly improved survival. Total glossectomy is feasible and safe in both the primary and salvage setting and should be considered as the surgical option for advanced tongue cancer.
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Affiliation(s)
- H Nemade
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - A Chaitanya S
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India.
| | - S Kumar
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - A K A
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - T S Rao
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - L M C S Rao S
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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Subramaniam N, Poptani H, Schache A, Bhat V, Iyer S, Sunil HV, Chandrasekhar N, Pillai V, Chaturvedi P, Krishna S, Krishnamurthy A, Kekatpure V, Kuriakose M, Iyer NG, Thakkar A, Kantharia R, Sonkar A, Shetty V, Rangappa V, Kolur T, Vidhyadharan S, Murthy S, Kudpaje A, Srinivasalu V, Mahajan A. Imaging advances in oral cavity cancer and perspectives from a population in need: Consensus from the UK-India oral cancer imaging group. JOURNAL OF HEAD & NECK PHYSICIANS AND SURGEONS 2021. [DOI: 10.4103/jhnps.jhnps_10_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pyne JM, Dziegielewski PT, Constantinescu G, Dzioba A, O'Connell DA, Côté DWJ, Ansari K, Harris J, Conrad D, Makki FM, Hearn M, Biron VL, Seikaly H. The Functional & Quality of Life Outcomes of Total Glossectomy with Laryngeal Preservation. Laryngoscope Investig Otolaryngol 2020; 5:853-859. [PMID: 33134532 PMCID: PMC7585251 DOI: 10.1002/lio2.435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/01/2020] [Accepted: 07/11/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The tongue is an essential organ for human interaction, communication and survival. To date, there is a paucity of objective functional, patient reported, or quality of life outcomes of patients undergoing a total glossectomy with preservation of the larynx (TGLP). OBJECTIVE To examine prospectively collected objective, self-reported functional and quality of life (QOL) data in patients undergoing TGLP and free flap reconstruction. METHODS Sixteen TGLP patients were identified in the prospective head and neck cancer and functional outcomes database between January of 2009 and December 2017. Data collection included patient age, sex, performance status, TNM staging, diagnosis and adjuvant treatment. Swallowing and speech functions were measured and prospectively recorded pre- and postoperatively. Patient reported outcomes were measured with the Speech Handicap Index (SHI) and the M.D. Anderson Dysphagia Inventory (MDADI). RESULTS All patients had a significant reduction in their objective swallowing (P = 0.035), sentence (P = 0.001) and word intelligibility (P < .001) scores. There was no significant reduction in SHI or total MDADI scores. All patients maintained their QOL in the post-treatment time frame. There was no relationship between free-flap type and outcome. CONCLUSION Total glossectomy with laryngeal sparing and free flap reconstruction results in significant reduction in objective functional measurements, but patients report stable functional and quality of life outcomes after treatment.
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Affiliation(s)
- Justin M. Pyne
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | | | - Gabriela Constantinescu
- Institute for Reconstructive Sciences in MedicineCaritas Health GroupEdmontonAlbertaCanada
- Communication Sciences and DisordersUniversity of AlbertaEdmontonAlbertaCanada
| | - Agnieszka Dzioba
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Daniel A. O'Connell
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - David W. J. Côté
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Khalid Ansari
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Jeffrey Harris
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Dustin Conrad
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Fawaz M. Makki
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
- Department of Otolaryngology Head & Neck SurgeryKing Faisal Specialist Hospital & Research CenterRiyadhSaudi Arabia
| | - Matthew Hearn
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Vincent L. Biron
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Hadi Seikaly
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
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Kekatpure V, Neelakantan V, Shetkar G. Total glossectomy: Technique review. JOURNAL OF HEAD & NECK PHYSICIANS AND SURGEONS 2020. [DOI: 10.4103/jhnps.jhnps_23_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Han AY, Kuan EC, Mallen-St Clair J, Badran KW, Palma Diaz MF, Blackwell KE, St John MA. Total Glossectomy With Free Flap Reconstruction: Twenty-Year Experience at a Tertiary Medical Center. Laryngoscope 2019; 129:1087-1092. [PMID: 30667056 DOI: 10.1002/lary.27579] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To characterize the demographics, clinicopathologic characteristics, and treatment and reconstructive outcomes of patients who underwent total glossectomy STUDY DESIGN: Retrospective chart review at an academic tertiary-care medical center. METHODS All patients who had undergone total glossectomy (as an individual procedure or as part of a more extensive resection) between January 1, 1995 and December 31, 2014 were included in the analysis. Patient characteristics and clinical outcomes were reviewed. RESULTS Forty-eight patients underwent total glossectomy for oral tongue and base of tongue cancer. The mean age of the patients was 56 (range, 29-92 years). History of tobacco and heavy alcohol use was found in 76% and 11% of patients, respectively. The majority of patients had advanced cancer (91.7% at stage IV), and 60.4% had salvage therapy for recurrent disease. T4 disease comprised 81% of patients. Sixty percent had clinical or radiographic evidence of nodal metastasis. Reconstruction of the defect was performed with free flaps from the rectus abdominus (40%), fibula (25%), anterolateral thigh (23%), and other donor tissues. One- and 5-year survival rates were 42% and 26%, with locoregional and distant recurrence reported at 36% and 25%, respectively. CONCLUSIONS Total glossectomy for oncologic control is most commonly performed in patients who have stage IV cancers. Despite high reconstructive success rates, the likelihood of locoregional and distance recurrence was high. Most patients can communicate intelligibly and achieve decannulation, but swallowing outcomes remain guarded, especially considering previous irradiation and resection of the base of tongue. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1087-1092, 2019.
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Affiliation(s)
- Albert Y Han
- Department of Head and Neck Surgery, Los Angeles, California
| | - Edward C Kuan
- Department of Head and Neck Surgery, Los Angeles, California
| | - Jon Mallen-St Clair
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco Medical Center, San Francisco, California, U.S.A
| | - Karam W Badran
- Department of Head and Neck Surgery, Los Angeles, California
| | | | - Keith E Blackwell
- Department of Head and Neck Surgery, Los Angeles, California.,University of California, Los Angeles Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California
| | - Maie A St John
- Department of Head and Neck Surgery, Los Angeles, California.,Jonsson Comprehensive Cancer Center, Los Angeles, California.,University of California, Los Angeles Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California
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Mannelli G, Arcuri F, Agostini T, Innocenti M, Raffaini M, Spinelli G. Classification of tongue cancer resection and treatment algorithm. J Surg Oncol 2018; 117:1092-1099. [DOI: 10.1002/jso.24991] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Giuditta Mannelli
- Unit of Otorhinolaryngology−Head and Neck Surgery; Department of Surgery and Translational Medicine; University of Florence; AOU-Careggi; Florence Italy
| | | | | | - Marco Innocenti
- Department of Plastic and Reconstructive Microsurgery; Careggi University Hospital; Florence Italy
| | - Mirco Raffaini
- Maxillo-Facial Surgery Unit; AOU-Careggi; Florence Italy
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Keski-Säntti H, Bäck L, Lassus P, Koivunen P, Kinnunen I, Blomster H, Mäkitie AA, Aro K. Total or subtotal glossectomy with laryngeal preservation: a national study of 29 patients. Eur Arch Otorhinolaryngol 2017; 275:191-197. [DOI: 10.1007/s00405-017-4789-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022]
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Mazarro A, de Pablo A, Puiggròs C, Velasco MM, Saez M, Pamias J, Bescós C. Indications, reconstructive techniques, and results for total glossectomy. Head Neck 2016; 38 Suppl 1:E2004-10. [DOI: 10.1002/hed.24369] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/30/2015] [Accepted: 11/25/2015] [Indexed: 01/03/2023] Open
Affiliation(s)
- Alejandro Mazarro
- Oral and Maxillofacial Department; Hospital Vall d'Hebron; Barcelona Spain
| | - Alba de Pablo
- Oral and Maxillofacial Department; Hospital Vall d'Hebron; Barcelona Spain
| | | | - Mª Mercedes Velasco
- Department of Phoniatry and Logopedy - Rehabilitation Service; Hospital Vall d'Hebron; Barcelona Spain
| | - Manel Saez
- Oral and Maxillofacial Department; Hospital Vall d'Hebron; Barcelona Spain
| | - Jorge Pamias
- Oral and Maxillofacial Department; Hospital Vall d'Hebron; Barcelona Spain
| | - Coro Bescós
- Oral and Maxillofacial Department; Hospital Vall d'Hebron; Barcelona Spain
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Total glossectomy without laryngectomy - a review of functional outcomes and reconstructive principles. Curr Opin Otolaryngol Head Neck Surg 2015; 22:414-8. [PMID: 25003844 DOI: 10.1097/moo.0000000000000076] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of functional outcomes and reconstructive principles of total glossectomy without laryngectomy reported in recent series, and the evidence regarding which patients are at risk for poor functional outcomes. RECENT FINDINGS After total glossectomy with laryngeal preservation gastric tube dependency ranges from 30 to 44% for primary treatment. Between 85 and 95% of patients are able to have their tracheostomy tube removed. Many patients can also regain meaningfully intelligible speech. In the setting of prior radiation or chemoradiation therapy, achieving oral diet and tracheostomy decannulation is less likely.Reconstructions must have sufficient bulk to allow for contact with the palate, and achievement of this vertical height has been shown to be associated with improved speech and swallowing outcomes. Laryngeal suspension is an important adjunct to prevent both laryngeal prolapse and minimize aspiration risk. The role of either sensory or motor reinnervation is unclear, although there is currently more evidence for the benefit of sensory reinnervation. SUMMARY With meticulous reconstructive technique and appropriate patient selection, total glossectomy with laryngeal preservation can be performed as a primary or salvage procedure with acceptable functional outcomes.
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Bastos de Souza TR, Pinto CAL, da Cunha Mercante AM, Nishimoto IN, Brasilino de Carvalho M, Kowalski LP. Long-term results of surgical treatment for advanced oropharyngeal squamous cell carcinoma. Head Neck 2013; 36:1146-54. [PMID: 23897725 DOI: 10.1002/hed.23427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 04/29/2013] [Accepted: 06/26/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to review the oncologic and functional outcomes of patients with clinical stage III or IV squamous cell carcinoma (SCC) of the oropharynx submitted to tumor resection and neck dissection with or without postoperative radiotherapy (PORT). METHODS We conducted a retrospective review of medical charts of 256 consecutive patients. RESULTS Fatal postoperative complications were registered in 5 patients (1.9%). During follow-up, there were 74 local recurrences (29%), 27 neck recurrences (10.5%), and 19 distant metastases (7.4%). The 5-year overall survival (OS) was 43.0%. The Cox multivariate model identified pT3 and pT4, pN2 and pN3, and an intense lymphocytic infiltrate as independent prognostic markers for OS. The 5-year disease-free survival (DFS) rate was 54.5%. CONCLUSION Surgical treatment for oropharyngeal carcinoma can be performed with a low-risk of postoperative mortality but with a risk of long-term use of tracheostomy and feeding tubes.
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Affiliation(s)
- Tânia Regina Bastos de Souza
- Head and Neck Surgery and Otorhinolaryngology Department, Hospital A C Camargo, São Paulo, Brazil; Head and Neck Surgery Service, Hospital Heliopolis, São Paulo, Brazil
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Navach V, Zurlo V, Calabrese L, Massaro MA, Bruschini R, Giugliano G, Ansarin M, Chiesa F. Total glossectomy with preservation of the larynx: oncological and functional results. Br J Oral Maxillofac Surg 2013; 51:217-23. [DOI: 10.1016/j.bjoms.2012.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 07/16/2012] [Indexed: 10/28/2022]
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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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Balasubramanian D, Thankappan K, Kuriakose MA, Duraisamy S, Sharan R, Mathew J, Sharma M, Iyer S. Reconstructive indications of simultaneous double free flaps in the head and neck: a case series and literature review. Microsurgery 2012; 32:423-30. [PMID: 22438175 DOI: 10.1002/micr.21963] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 12/20/2011] [Accepted: 12/28/2011] [Indexed: 11/11/2022]
Abstract
Extensive and complex defects of the head and neck involving multiple anatomical and functional subunits are a reconstructive challenge. The purpose of this study is to elucidate the reconstructive indications of the use of simultaneous double free flaps in head and neck oncological surgery. This is a retrospective review of 21 consecutive cases of head and neck malignancies treated surgically with resection and reconstruction with simultaneous use of double free flaps. Nineteen of 21 patients had T4 primary tumor stage. Eleven patients had prior history of radiotherapy or chemo-radiotherapy. Forty-two free flaps were used in these patients. The predominant combination was that of free fibula osteo-cutaneous flap with free anterolateral thigh (ALT) fascio-cutaneous flap. The indications of the simultaneous use of double free flaps can be broadly classified as: (a) large oro-mandibular bone and soft tissue defects (n = 13), (b) large oro-mandibular soft tissue defects (n = 4), (c) complex skull-base defects (n = 2), and (d) dynamic total tongue reconstruction (n = 2). Flap survival rate was 95%. Median follow-up period was 11 months. Twelve patients were alive and free of disease at the end of the follow-up. Eighteen of 19 patients with oro-mandibular and glossectomy defects were able to resume an oral diet within two months while one patient remained gastrostomy dependant till his death due to disease not related to cancer. This patient had a combination of free fibula flap with free ALT flap, for an extensive oro-mandibular defect. The associated large defect involving the tongue accounted for the swallowing difficulty. Simultaneous use of double free flap aided the reconstruction in certain large complex defects after head and neck oncologic resections. Such combination permits better complex multiaxial subunit reconstruction. An algorithm for choice of flap combination for the appropriate indications is proposed.
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Affiliation(s)
- Deepak Balasubramanian
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Current management of advanced resectable oral cavity squamous cell carcinoma. Clin Exp Otorhinolaryngol 2011; 4:1-10. [PMID: 21461056 PMCID: PMC3062220 DOI: 10.3342/ceo.2011.4.1.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 12/06/2010] [Indexed: 01/03/2023] Open
Abstract
The oral cavity is the most common site of head and neck squamous cell carcinoma, a disease which results in significant morbidity and mortality worldwide. Though the primary modality of treatment for patients with oral cavity cancer remains surgical resection, many patients present with advanced disease and are thus treated using a multi-disciplinary approach. Patients with extracapsular spread of lymphatic metastasis and surgical margins that remain positive have been found to be at high risk for local-regional recurrence and death from disease, and are most often recommended to receive both post-operative radiation as well as systemic chemotherapy. The basis for this approach, as well as scientific developments that underly future trials of novels treatments for patients with high-risk oral cavity cancer are reviewed.
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