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Lane C, Myers C, Jiang D, Cooke A, Kerr P. Selected functional outcomes in advanced oral cancer: Comparison of surgery alone versus surgery with postoperative radiotherapy. Head Neck 2021; 44:710-721. [PMID: 34939707 DOI: 10.1002/hed.26968] [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: 04/11/2021] [Revised: 11/22/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Study objectives were to determine whether the addition of postoperative radiation (PORT) resulted in a decline in oral function relative to surgery alone and to describe the longitudinal course of oral function following treatment of advanced oral cancer. METHODS This was a 36-month retrospectively analyzed observational cohort study of patients with stage III-IV oral cancer. Prospectively collected, oral functional outcomes were acquired pretreatment and 3, 6, 12, 24, and 36 months post-treatment. RESULTS One hundred and eighteen patients were included. Forty-three patients treated with surgery alone were compared to 75 who received surgery with PORT. Mixed model analysis demonstrated the acute effect of PORT was associated with patient-rated xerostomia (p < 0.001) and the late or persistent effect was associated with decreased clinician-rated eating in public (p = 0.008), understandability of speech (p = 0.02), and normalcy of diet (p = 0.005) compared with surgery alone. There were no differences between surgery alone and PORT groups in clinician-rated feeding tube dependence or patient-rated speech handicap. CONCLUSIONS The use of PORT was associated with a demonstrable decline in oral function in four of six outcomes measures relative to surgery alone.
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Affiliation(s)
- Ciaran Lane
- Department of Otolaryngology - Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Candace Myers
- Section of Communication Disorders, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Deping Jiang
- George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Cooke
- Department of Radiation Oncology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kerr
- Department of Otolaryngology - Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Idris S, Mlynarek AM, Ansari K, Harris JR, Rizk N, Cote D, O’Connell DA, Allen H, Dziegielewski P, Seikaly H. Multi-dimensional analysis of oral cavity and oropharyngeal defects following cancer extirpation surgery, a cadaveric study. J Otolaryngol Head Neck Surg 2018; 47:27. [PMID: 29690934 PMCID: PMC5978998 DOI: 10.1186/s40463-018-0276-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/20/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Defects following resection of tumors in the head and neck region are complex; more detailed and defect-specific reconstruction would likely result in better functional and cosmetic outcomes. The objectives of our study were: 1) to improve the understanding of the two- and three-dimensional nature of oral cavity and oropharyngeal defects following oncological resection and 2) to assess the geometric dimensions and the shapes of fasciocutaneous free flaps and locoregional tissue flaps required for reconstruction of these defects. METHODS This study was an anatomic cadaveric study which involved creating defects in the oral cavity and oropharynx in two cadaveric specimens. Specifically, partial and total glossectomies, floor of mouth excisions, and base of tongue excisions were carried out. These subsites were subsequently geometrically analyzed and their volumes measured. The two-dimensional (2D) assessment of these three-dimensional (3D) structures included measures of surface area and assessment of tissue contours and shapes. RESULTS The resected specimens all demonstrated unique dimensional geometry for the various anatomic sites. Using 2D analysis, hemiglossectomy defects revealed right triangle geometry, whereas total glossectomy geometry was a square. Finally, the base of tongue defects exhibited a trapezoid shape. CONCLUSIONS Customizing the geometry and dimensions of fasciocutaneous free flaps so that they are specific to the confronted head and neck defects will likely result in better functional and cosmetic outcomes.
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Affiliation(s)
- Sherif Idris
- Division of Otolaryngology—Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB T6G 2B7 Canada
| | - Alex M. Mlynarek
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montréal, Quebec, Canada
| | - Khalid Ansari
- Division of Otolaryngology—Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB T6G 2B7 Canada
| | - Jeffrey R. Harris
- Division of Otolaryngology—Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB T6G 2B7 Canada
| | - Nabil Rizk
- Division of Otolaryngology—Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB T6G 2B7 Canada
| | - David Cote
- Division of Otolaryngology—Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB T6G 2B7 Canada
| | - Daniel A. O’Connell
- Division of Otolaryngology—Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB T6G 2B7 Canada
| | - Heather Allen
- Division of Otolaryngology—Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB T6G 2B7 Canada
| | - Peter Dziegielewski
- Department of Otolaryngology—Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Hadi Seikaly
- Division of Otolaryngology—Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB T6G 2B7 Canada
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