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An investigation of the cutoff point of the English version of speech handicap index in the American total laryngectomees. LOGOP PHONIATR VOCO 2024; 49:34-40. [PMID: 35895076 DOI: 10.1080/14015439.2022.2102206] [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: 07/07/2021] [Revised: 05/24/2022] [Accepted: 07/08/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVES The present article aims to identify the optimal cutoff score and the diagnostic accuracy for the English version of Speech Handicap Index (SHI) to screen out individuals with and without speech disorders in daily life. MATERIALS AND METHODS In this cross-sectional cohort study, a volunteer sample of 104 adult patients after total laryngectomy and 99 healthy controls in the United States completed the English version of SHI online questionnaire. Sensitivity and specificity were computed for a range of cut-off values using the Receiving Operating Characteristics (ROC) analysis to establish an optimal cutoff point for the SHI. Other measures of diagnostic accuracy, such as likelihood ratios (LR), positive predictive values (PPV), and negative predictive values (NPV) were also computed. RESULTS Patients after total laryngectomy obtained a higher score than the healthy controls on the mean scores of SHI. According to the ROC analysis, an optimal cutoff score of 17 points determined by Youden index was identified on the head and neck cancer population with a sensitivity of 92.31%, specificity of 92.31%, PPV of 90.60%, NPV of 91.75%, LR + of 9.14, and LR- of 0.09. CONCLUSIONS The cutoff score of the English version of SHI applied on the English-speaking population in the United States demonstrated promising diagnostic accuracy.
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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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Functional outcomes and complications of total glossectomy with laryngeal preservation and flap reconstruction: A systematic review and meta-analysis. Oral Oncol 2023; 141:106415. [PMID: 37149955 DOI: 10.1016/j.oraloncology.2023.106415] [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: 01/04/2023] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To analyze the functional outcomes and complications of total glossectomy with laryngeal preservation and reconstruction with free or pedicled flaps. METHODS A search was conducted using Pubmed/MEDLINE, Cochrane Library, Scopus, and Google Scholar databases. A single arm meta-analysis was performed for feeding tube dependence (FTD), tracheostomy dependence (TD), and speech intelligibility (SI) rates. Peri-operative sequels and complications were evaluated as secondary outcomes. RESULTS A total number of 642 patients (median age: 54.2 years; 95% CI 52.1-58) were included. Functional assessment was performed after a median of 12 months (n = 623/642; 95% CI 10.6-12). Overall, the cumulative FTD rate was 22.9% (n = 188/627; 95% CI 10.2-38.7), the TD rate was 7.3% (n = 95/549; 95% CI 1.9-15.8), and the SI was 91.1% (n = 314/409; 95% CI 80.7%-97.8). The cumulative complication rate was 33.1% (n = 592/642). Eighteen patients (n = 18/592; 3.0%) experienced a major fistula, while aspiration pneumonia occurred in 17 cases (n = 17/592; 2.8%). CONCLUSIONS Total glossectomy with laryngeal preservation and pedicled/free flaps reconstruction may guarantee good functional results and an acceptable quality of life. Further prospective studies are advised to define clinical guidelines about proper patients' and flaps' selection.
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Survival and functional outcomes after total glossectomy with total laryngectomy: Case series from a high-volume tertiary institution. Oral Oncol 2023; 137:106301. [PMID: 36586379 DOI: 10.1016/j.oraloncology.2022.106301] [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: 09/08/2022] [Revised: 12/16/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Total glossectomy with total laryngectomy (TGTL) is indicated for some cases of advanced oral squamous cell carcinoma. However, this procedure is rarely performed, as quality of life outcomes are often considered poor. Consequently, few studies to date have reported survival and functional outcomes in patients undergoing TGTL. Here, we present the largest cases series to date of TGTL patients and provide relevant data on survival and functional outcomes. METHODS Patients met inclusion criteria if they underwent TGTL (concurrent or staged) indicated for head and neck squamous cell carcinoma. Patient demographics and disease characteristics, survival outcomes, functional oral intake scores, time to oral intake, gastrostomy tube dependence, and communication methods post-surgery were retrospectively extracted from the electronic medical record. RESULTS Survival in patients undergoing TGTL was poor. Most patients in this study were eventually approved for some oral intake of restricted consistencies but remained gastrostomy tube dependent for most of their nutritional needs. Baseline oral intake was suboptimal in most patients but often re-achieved approximately 12 months following surgery. Communication methods following surgery included writing, text-to-speech, and augmentative and alternative communication devices. CONCLUSION Our data provide new insights comparing survival and functional outcomes of patients undergoing TGTL. Additional investigation particularly on patient-perceived quality of life following TGTL is needed to better understand the risks and benefits for patients who are candidates for TGTL.
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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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Salvage total glossectomy and total glosso-laryngectomy: Are they worth it? A GETTEC French multicenter study. Oral Oncol 2022; 130:105896. [PMID: 35567979 DOI: 10.1016/j.oraloncology.2022.105896] [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: 02/11/2022] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Salvage total glossectomy (TG) or total glosso-laryngectomy (TGL) remain controversial, as highly morbid procedures. The objective was to describe oncological and functional outcomes after salvage TG or TGL. METHODS We performed a multicenter retrospective study, including patients with previous neck irradiation undergoing TG or TGL for squamous cell carcinoma involving the base of tongue. RESULTS We included 42 patients: 27 in the TG group and 15 in the TGL group. For the entire cohort, median OS and DFS were estimated at 19 months (95% IC [14-44]) and 10 months (95% IC [7-13]) respectively, with no difference between the two groups. After a median follow-up of 90 months, 10 patients (24%) were alive and free of disease. Att he end of follow-up, we noted a gastrostomy dependency of 89% and 87 %respectively in the TG and TGL group, and 48% of patients in the TG group had a tracheotomy. CONCLUSION Although local control is difficult to achieve after salvage TG or TGL, these procedures are associated with acceptable survival and chance of cure for a last-resort situation. TG and TGL can be proposed in selected motivated patients after careful shared decision-making.
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Survival, functional, and quality of life outcomes between total glossectomy with and without total laryngectomy: A narrative review. Am J Otolaryngol 2022; 43:103440. [PMID: 35398743 DOI: 10.1016/j.amjoto.2022.103440] [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: 02/24/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND A total glossectomy (TG) may be required for advanced tongue tumors. TG with total laryngectomy (TGL) may be indicated in some cases with tumor extension into the larynx or high risk of aspiration. Total glossectomy with laryngeal preservation (TGLP) may preserve phonation ability relative to TGL, yet TGLP may increase the risk of aspiration. METHODS For this narrative review, we performed a comprehensive literature search of studies relevant to TG and TGL. Clinical studies investigating survival, functional outcomes, and quality of life in following TGLP or TGL were of particular interest. RESULTS Few studies in the literature directly compare survival, functional, and quality of life (QOL) outcomes between TGLP and TGL. TGLP is associated with intelligible speech. However, studies investigating gastrostomy tube dependence following TGLP versus TGL have generated conflicting results. CONCLUSION Further research on functional and QOL outcomes in patients undergoing TGL or TGLP is needed.
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Using the PRAAT software to describe dependence of speech intelligibility on tongue mobility in 6 patients after salvage glossectomy and reconstruction with a serratus anterior free flap. Clin Otolaryngol 2021; 46:1100-1105. [PMID: 33773035 DOI: 10.1111/coa.13773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/26/2021] [Accepted: 03/14/2021] [Indexed: 11/28/2022]
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Cultural Adaptation and Validation of Speech Handicap Index: A Scoping Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:748-760. [PMID: 33647211 DOI: 10.1044/2020_ajslp-20-00236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objectives The Speech Handicap Index (SHI) is a self-reported speech-related quality of life assessment originally developed for measuring the psychosocial speech impact in patients with oral or pharyngeal cancer. This review article provides a scoping review of the literature on the validated SHI, with the purpose of identifying and documenting available studies and procedures for the cultural adaption and validation of SHI. Method Prime databases including PubMed, EMBASE, and Google Scholar were searched for journal publications reporting validation of the SHI. Reviews and reference cross-checking were performed using a priori selection criteria. A body of literature related to SHI was scoped and publication quality was categorized independently by two investigators. After applying all the screening criteria, articles that met the eligibility criteria were included in the review. Results The scoping review yielded 10 articles that met the inclusion criteria presenting the SHI in eight different languages, including Dutch, U.K. English, French, Korean, Simplified Chinese (Mandarin), Lithuanian, Italian, and European Portuguese. All of them reported validity, reliability, and translation method. Discussion and Conclusions High reliability and validity between various language versions of the SHI were identified. The current scoping review provides a useful summary and could be a helpful precursor to a systematic review on SHI in the future. Supplemental Material https://doi.org/10.23641/asha.14082704.
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Oncological outcomes in patients undergoing major glossectomy for advanced carcinoma of the oral tongue. Ann R Coll Surg Engl 2020; 102:514-518. [PMID: 32436723 DOI: 10.1308/rcsann.2020.0100] [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: 11/22/2022] Open
Abstract
INTRODUCTION Major glossectomy is the treatment of choice in locally advanced tongue cancer. It remains the only option in the presence of recurrent or residual disease. The long-term outcomes for patients undergoing major glossectomy have traditionally been poor, with significant morbidity and poor oncological outcomes. The aim of this study was to report on oncological outcomes in patients undergoing major glossectomy. METHODS All patients undergoing major glossectomy between 2014 and 2018 were included in the study. The data of 85 patients with advanced carcinoma of the oral tongue were evaluated. All were under the care of a single surgical and reconstructive team at two hospitals in Mumbai. RESULTS The median patient age was 45 years. At the most recent follow-up, 55 patients (65%) were alive, 47 of whom were disease free. Twenty-nine patients (34%) had locoregional recurrence and twenty-five (29%) had distant metastasis. At a median follow-up of 19 months, rates for 2-year locoregional control, disease free survival (DFS) and overall survival (OS) were 69%, 61% and 62% respectively. Perinodal extension demonstrated a trend towards poor DFS (p=0.060), as did perineural invasion (p=0.055). Node positivity was a significant factor for poor OS, DFS and locoregional control. Multiple node involvement was significantly associated with poor OS on multivariate analysis (p=0.002). CONCLUSIONS Node positivity and multiple node involvement were associated with poor outcomes. Major glossectomy may be offered as a curative option for selected patients with advanced carcinoma of the oral tongue with node negative or limited neck nodal disease (N1).
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Functional outcomes and survival of patients with oral and oropharyngeal cancer after total glossectomy. Braz J Otorhinolaryngol 2019; 86:545-551. [PMID: 30956152 PMCID: PMC9422732 DOI: 10.1016/j.bjorl.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/10/2018] [Accepted: 02/11/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Cancer of the oral cavity and oropharynx presents aggressive behavior and its diagnosis is, in most cases, performed in advanced stages. Total glossectomy is a therapeutic option in locally advanced cancer, and the only one in the recurrent or residual disease, after chemoradiotherapy. OBJECTIVE To evaluate the clinical-epidemiological profile, postoperative complications, survival rates and functional aspects of patients with oral cavity and oropharynx cancer after total glossectomy. METHODS It was a retrospective study where 22 patients were included with oral cavity and oropharyngeal cancer after total glossectomy at the Hospital Regional do Vale do Paraíba, em Taubaté, São Paulo. RESULTS All patients were male, with a median age of 57 years, most of tumors are located in the tongue and floor of the mouth and classified as stage IVa. Total glossectomy as initial treatment was performed in 18 and as salvage in four patients. The major pectoralis myocutaneous flap was used for reconstruction in all cases. The main postoperative complication was wound infection and salivary fistula. CONCLUSION Overall survival was 19% and cancer-specific survival was 30.8% in five years. Eight patients were rehabilitated for exclusive oral feeding without the dependence tracheostomy and enteral tube, all with an overall survival greater than 15 months.
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Pharyngeal reconstruction by anterolateral thigh flap with vastus lateralis muscle transfer for effective swallowing after total glossolaryngectomy: A case report. Head Neck 2019; 41:E120-E124. [PMID: 30861231 DOI: 10.1002/hed.25735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/31/2018] [Accepted: 02/19/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We report a novel reconstruction technique that maintained effective swallowing after total glossolaryngectomy (TGL) by restoring pharyngeal constriction using a vascularized vastus lateralis muscle transfer. METHODS A 65-year-old male with recurrent tongue cancer underwent TGL and anterolateral thigh flap reconstruction with the vastus lateralis muscle. The bilateral cut ends of the remaining posterior pharyngeal wall constrictor muscle were sutured to the transferred vastus lateralis muscle so that the two muscles encircled the reconstructed pharynx. The femoral nerve of the vastus lateralis muscle was coapted to the hypoglossal nerve. RESULTS Videofluorographic examination showed the contrast bolus flowing smoothly with little assistance from gravity. Laryngoscopic examination showed circumferential constriction of the reconstructed pharynx. The patient could swallow soft food without placing the bolus in his posterior oral cavity or drinking simultaneously. CONCLUSION The restoration of pharyngeal constriction introduces the possibility of functional swallowing in patients after TGL.
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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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Use of the myocutaneous serratus anterior free flap for reconstruction after salvage glossectomy. Eur Arch Otorhinolaryngol 2018; 276:559-566. [PMID: 30552516 PMCID: PMC6394427 DOI: 10.1007/s00405-018-5245-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/08/2018] [Indexed: 11/29/2022]
Abstract
Purpose To describe the use of a myocutaneous serratus anterior free flap (SAFF) for tongue reconstruction after salvage subtotal (STG) and total glossectomy (TG). Methods In this prospective case series, seven patients underwent salvage STG or TG and reconstruction with a myocutaneous SAFF between 10/2015 and 02/2017. Functional and oncologic outcomes were prospectively evaluated. Donor side morbidity was determined using the Disabilities of the Arm, Shoulder and Hand (DASH) score. Results SAFF with mean skin paddles of 6.7 cm × 8.7 cm was used in five STG and two TG patients, respectively. There was a 100% flap survival and a mean DASH score of 10.8 reflected normal arm and shoulder function after surgery. One year after salvage surgery, 1 (14.3%) and 4 (57.1%) patients were tracheostomy and gastrostomy tube dependent. Gastrostomy tube dependence was significantly worse in patients with tumors of the base of tongue compared to other tumor sites (p = 0.030) and in patients who underwent transcervical compared to transoral tumor resection (p = 0.008). Local recurrence rate was 57.1% with a disease-free survival of 17.6 months. Conclusion The myocutaneous SAFF represents a safe and reliable flap for tongue reconstruction after salvage glossectomy with satisfying functional outcomes and low donor side morbidity.
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Total glossolaryngectomy cohort study (N = 25): Survival, function and quality of life. Clin Otolaryngol 2018; 43:1349-1353. [PMID: 29667326 DOI: 10.1111/coa.13121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2018] [Indexed: 11/28/2022]
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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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Modified pectoralis major myocutaneous flap for the total glossectomy defects: Effect on quality of life. J Surg Oncol 2016; 114:32-5. [DOI: 10.1002/jso.24260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/31/2016] [Indexed: 11/10/2022]
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Evaluation of the safety and efficacy of carbon ion radiotherapy for locally advanced adenoid cystic carcinoma of the tongue base. Head Neck 2016; 38 Suppl 1:E2122-6. [PMID: 26854882 DOI: 10.1002/hed.24397] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Most cases of adenoid cystic carcinoma (ACC) of the tongue base are radioresistant, and are diagnosed in the advanced stage. Therefore, we evaluated the safety and efficacy of carbon ion radiotherapy (C-ion RT) for locally advanced ACC of the tongue base. METHODS Eighteen patients with ACC of the tongue base were treated with C-ion RT between May 2002 and April 2014. Seventeen patients had T4a disease and 1 patient had T2 disease before C-ion RT. RESULTS The median follow-up period was 57 months (range, 10-132 months). The 5-year local control rate was 92%. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 72% and 44%, respectively. Regarding late reactions, 2 patients developed grade 3 mandible osteoradionecrosis, and 1 had grade 3 hemorrhage of the tongue base. CONCLUSION C-ion RT was effective with acceptable toxicities for locally advanced ACC of the tongue base. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2122-E2126, 2016.
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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
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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]
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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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Flap selection and functional outcomes in total glossectomy with laryngeal preservation. Otolaryngol Head Neck Surg 2013; 149:547-53. [PMID: 23884285 DOI: 10.1177/0194599813498063] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Reconstruction of total glossectomy defects has been revolutionized by the popularity of free flap use in the head and neck. Challenging defects can be addressed with a variety of different free and pedicled flaps. The purpose of this study is to review our method of flap selection in cases of total glossectomy defects with laryngeal preservation, with an emphasis on the variations of these defects and patient body habitus. STUDY DESIGN Case series with chart review. SETTING Tertiary care referral center. SUBJECTS AND METHODS All patients undergoing total glossectomy with laryngeal preservation (TGLP) by the senior author (YD) from September 1997 to May 2012. Objective data regarding patient demographics, existing defect, method of reconstruction, adjuvant treatment, operative details, outcomes, and complications were recorded. Both means and frequency of prolonged tracheostomy or gastrostomy tube were used to assess outcomes. RESULTS One hundred and three patients were identified. Ninety-four met inclusion criteria. All patients were T3 or T4 stage tumors. Mean follow-up was 3.4 years. Fifty-nine patients (62%) underwent free flap reconstruction while the remaining 35 (37%) were treated with a pedicled pectoralis myocutaneous flap. Tracheostomy decannulation and gastrostomy tube removal rates were 84% and 29%, respectively. No patients were converted to total laryngectomy. CONCLUSION Optimal reconstruction of TGLP defects may be accomplished with either pedicled or free-tissue flap reconstruction. Selecting an ideal flap for reconstruction of total glossectomy defects should be patient specific and based on matching donor flap bulk. This treatment approach demonstrates high tracheostomy and gastric tube independence.
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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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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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