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Evaluation of Tongue Functions After Free Flap Reconstruction

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Squamous cell carcinoma of the tongue is the most common malignancy of the oral cavity, the lateral border being the commonest site. The treatment strategies mandate surgery followed by appropriate reconstruction as the first line of management. There are many suitable methods of reconstruction of tongue defects after surgery, but the principle of an ideal reconstruction method should provide not only satisfactory structural cosmesis, but also good restoration of function. We present our experience with the skin lined free flaps reconstruction for defects of the tongue and floor of mouth, and present analyses of the functional outcomes of reconstruction. This prospective longitudinal study included 93 patients and was conducted in a tertiary care center in Punjab. All patients underwent free flap reconstruction after tumor removal. The functional outcome of the tongue following reconstruction was evaluated 9 months after the completion of treatment. Functions were assessed and matched with sexes and age-matched normal individuals. The data obtained were analyzed by the student ‘t’ test and the p values < 0.05 were considered statistically significant. The duration of swallowing in patients with FRF flap and ALT flap when compared to the normative was significant (< 0.05). There were changes in configuration and volume of the oral cavity after surgery which generates resonant and articulatory alterations, thus the intelligibility of the patient’s speech is lowered. There is also a restriction in the tongue movements and reduction in the sensations of the reconstructed part of the tongue. Both the free ALT flap and the FRF flap can provide acceptable functional restoration of the tongue after radical tumor resection.

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The study is purely observational study of human participants done under the first author and is transparent without any manipulations or fraud statements.

References

  1. Garzino-Demo P, Dell’Acqua A, Dalmasso P, Fasolis M, La Terra Maggiore GM, Ramieri G et al (2006) Clinicopathological parameters and outcome of 245 patients operated for oral squamous cell carcinoma. J Craniomaxillofac Surg 34:344–350

    Article  PubMed  Google Scholar 

  2. Hsiao HT, Leu YS, Chang SH, Lee JT (2003) Swallowing function in patients who underwent hemiglossectomy: comparison of primary closure and free radial forearm flap reconstruction with videofluoroscopy. Ann Plast Surg 50:450–455

    Article  PubMed  Google Scholar 

  3. Joo YH, Hwang SH, Park JO, Cho KJ, Kim MS (2013) Functional outcome after partial glossectomy with reconstruction using radial forearmfree flap. Auris Nasus Larynx 40:303–307

    Article  PubMed  Google Scholar 

  4. Mascarella MA, Richardson K, Mlynarek A, Forest VI, Hier M, Sadeghi N et al (2019) Evaluation of a preoperative adverse event risk index for patients undergoing head and neck cancer surgery. JAMA Otolaryngol Head Neck Surg. https://doi.org/10.1001/jamaoto.2018.4513

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tarsitano A, Vietti MV, Cipriani R, Marchetti C (2013) Functional results of microvascular reconstruction after hemiglossectomy: free anterolateral thigh flap versus free forearm flap. Acta Otorhinolaryngol Italica 33:374

    CAS  Google Scholar 

  6. Engel H, Huang JJ, Lin CY, Lam W, Kao HK, Gazyakan E, Cheng MH (2010) A strategic approach for tongue reconstruction to achieve predictable and improved functional and aesthetic outcomes. Plast Reconstr Surg 2010:126

    Google Scholar 

  7. Yun IS, Lee DW, Lee WJ, Lew DH, Choi EC, Rah DK (2010) Correlation of neotongue volume changes with functional outcomes after long-term follow-up of total glossectomy. J Craniofac Surg 21:111–116

    Article  PubMed  Google Scholar 

  8. Revenaugh PC, Knott PD, Alam DS, Kmiecik J, Fritz MA (2013) Voice outcomes following reconstruction of laryngopharyngectomy defects using the radial forearm free flap and the anterolateral thigh flap. Laryngoscope 124:397–400 [Epub ahead of print]

    Article  PubMed  Google Scholar 

  9. Kaur R, Sahni VR, Choudhary S, Bharthuar A, Chopra S (2019) Functional outcomes of oral tongue reconstruction: a subjective analysis. J Head Neck Phys Surg 7:26–31

    Google Scholar 

  10. Hara I, Gellrich NC, Düker J, Schön R, Nilius M, Fakler O et al (2003) Evaluation of swallowing function after intraoral soft tissue reconstruction with microvascular free flaps. Int J Oral Maxillofac Surg 32:593–599

    Article  CAS  PubMed  Google Scholar 

  11. Song YG, Chen GZ, Song YL (1984) The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 37:149–159

    Article  CAS  PubMed  Google Scholar 

  12. Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH (2002) Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 109:2219–2226

    Article  PubMed  Google Scholar 

  13. Hanasono MM, Skoracki RJ, Yu P (2010) A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg 125:209–214

    Article  CAS  PubMed  Google Scholar 

  14. Revenaugh PC, Haffey TM, Seth R, Fritz MA (2014) Anterolateral thigh adipofascial flap in mucosal reconstruction. JAMA Facial Plast Surg 16:395–399

    Article  PubMed  Google Scholar 

  15. Huang SH, Wu SH, Chang KP, Wang WH, Lai CH, Sun IF et al (2009) Contour refinements of free flaps for optimal outcome in oral reconstruction: combination of modified liposuction technique and w-plasty in one-stage procedure. J Craniomaxillofac Surg 37:201–205

    Article  PubMed  Google Scholar 

  16. Yang GF, Chen PJ, Gao YZ, Liu XY, Li J, Jiang SX et al (1997) Forearm free skin flap transplantation: a report of 56 cases. 1981. Br J Plast Surg 50:162–165

    Article  CAS  PubMed  Google Scholar 

  17. Timmons MJ, Missotten FE, Poole MD, Davies DM (1986) Complications of radial forearm flap donor sites. Br J Plast Surg 39:176–178

    Article  CAS  PubMed  Google Scholar 

  18. Yang JY, Tsai FC, Chana JS (2002) Use of free thin anterolateral thigh flaps combined with cervicoplasty for reconstruction of postburn anterior cervical contractures. Plast Reconstr Surg 110:39–46

    Article  PubMed  Google Scholar 

  19. De Carvalho-Teles V, Sennes LU, Iv G (2008) Speech evaluation after palatal augmentation in patients undergoing glossectomy. Arch Otolaryngol Head Neck Surg 134:1066–1070

    Article  PubMed  Google Scholar 

  20. Watts CR, Hamilton A, Toles L, Childs L, Mau T (2015) A randomized controlled trial of stretch-and-flow voice therapy for muscle tension Dysphonia. Laryngoscope 125:1420–1425

    Article  PubMed  Google Scholar 

  21. Joo YH, Hwang SH, Park JO, Cho KJ, Kim MS (2013) Functional outcome after partial glossectomy with reconstruction using radial forearm free flap. Auris Nasus Larynx 40:303–307

    Article  PubMed  Google Scholar 

  22. Ha J, Sung I-Y, Son J-h, Stone M, Ord R, Cho Y-C (2016) Analysis of speech and tongue motion in normal and post-glossectomy speaker using cine MRI. J Appl Oral Sci 24(5):472–480

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bhaskararao P (2005) Salient phonetic features of Indian languages in speech technology. Sadhana 36(5):587–599

    Article  Google Scholar 

  24. Elfring TT, Boliek CA, Seikaly H, Harris J, Rieger JM (2011) Sensory outcomes of the anterior tongue after lingual nerve repair in oropharyngeal cancer. J Oral Rehabil 39(3):170–181

    Article  PubMed  Google Scholar 

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Correspondence to Vanita Sarin.

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Sarin, V., Chatterjee, A., Kakkar, V. et al. Evaluation of Tongue Functions After Free Flap Reconstruction. Indian J Otolaryngol Head Neck Surg 74 (Suppl 2), 2398–2403 (2022). https://doi.org/10.1007/s12070-020-02177-1

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  • DOI: https://doi.org/10.1007/s12070-020-02177-1

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