Quality of life, swallowing and speech outcomes after oncological treatment for mobile tongue carcinoma

  • Molteni Gabriele
  • Ghirelli Michael
  • Molinari GiuliaEmail author
  • Sassu Alessandro
  • Malagoli Andrea
  • Marchioni Daniele
  • Presutti Livio
Original Paper



Surgical treatment of squamous cell carcinoma of the oral cavity (OSCC) has a high impact on patients’ quality of life (QoL), as it variably affects their ability to speak, swallow and their social life. It is still debatable whether free flap tongue reconstruction has significant functional advantages over non-reconstructing techniques after tongue resection.


A case-control retrospective study was performed involving 14 patients who underwent partial glossectomy with or without floor of the mouth resection for OSCC of the mobile tongue. After resection, seven patients were reconstructed with a microvascular free flap, while seven were closed primarily or healed by secondary intention. All patients were asked to fill four questionnaires investigating their quality of life. As objective evaluation of swallowing, each patient underwent a Fiberoptic Endoscopic Evaluation of Swallowing and a videofluoroscopy.


Questionnaires showed an optimal global quality of life and high functional outcomes in both groups. The objective evaluation of swallowing showed a prevailing difficulty in the oral phase in both groups, without further swallowing impairment. Our data confirm excellent speech, swallowing and life quality in both microvascular reconstruction and non-reconstructive techniques groups.


Acknowledging the limited number of cases, our study showed that speech, swallowing and QoL results are similar both after large tongue defects reconstructed by microvascular free flaps, and small tongue resections managed with non-reconstructive techniques. This further underlines the importance of microvascular free flaps after extended tongue resections.

Level of evidence: Level V, therapeutic study.


Tongue cancer Microvascular reconstruction Quality of life Swallowing Free flap 


Compliance with ethical standards

Conflict of interest

Molteni Gabriele, Ghirelli Michael, Molinari Giulia, Sassu Alessandro, Malagoli Andrea, Marchioni Daniele and Presutti Livio declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Comitato Etico dell’Area Vasta Emilia Nord, Modena; reference number 303/15) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    So WK, Chan RJ, Chan DN et al (2012) Quality-of-life among head and neck cancer survivors at one year after treatment–a systematic review. Eur J Cancer 48:2391–2408CrossRefGoogle Scholar
  2. 2.
    Urken ML, Moscoso JF, Lawson W, Biller HF (1994) A systematic approach to functional reconstruction of the oral cavity following partial and total glossectomy. Arch Otolaryngol Head Neck Surg 120:589–601CrossRefGoogle Scholar
  3. 3.
    Kao SS, Peters MD, Krishnan SG, Ooi EH (2016) Swallowing outcomes following primary surgical resection and primary free flap reconstruction for oral and oropharyngeal squamous cell carcinomas: a systematic review. Laryngoscope 126:1572–1580CrossRefGoogle Scholar
  4. 4.
    Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474CrossRefGoogle Scholar
  5. 5.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al (1993) The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRefGoogle Scholar
  6. 6.
    Bjordal K, Hammerlid E, Ahlner-Elmqvist M, de Graeff A, Boysen M, Evensen JF et al (1999) Quality of life in head and neck cancer patients: validation of the European organization for research and treatment of cancer quality of life questionnaire-H&N35. J Clin Oncol 17:1008–1019CrossRefGoogle Scholar
  7. 7.
    Jansen F, Snyder CF, Leemans CR, Verdonck-de Leeuw IM (2016) Identifying cutoff scores for the EORTC QLQ-C30 and the head and neck cancer–specific module EORTC QLQ-H&N35 representing unmet supportive care needs in patients with head and neck cancer. Head Neck 38(Suppl 1):E1493–E1500CrossRefGoogle Scholar
  8. 8.
    Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J et al (2001) The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the MD Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg 127:870–876PubMedGoogle Scholar
  9. 9.
    List MA, D’Antonio LL, Cella DF, Siston A, Mumby P, Haraf D et al (1996) The performance status scale for head and neck cancer patients and the functional assessment of cancer therapy-head and neck scale: A study of utility and validity. Cancer 77:2294–2301CrossRefGoogle Scholar
  10. 10.
    Martin-Harris B, Jones B (2008) The videofluorographic swallowing study. Phys Med Rehabil Clin N Am 19:769–785CrossRefGoogle Scholar
  11. 11.
    Colodny N (2002) Interjudge and intrajudge reliabilities in Fiberoptic Endoscopic Evaluation of Swallowing (Fees®) using the Penetration–Aspiration Scale: a replication study. Dysphagia 17:308–315CrossRefGoogle Scholar
  12. 12.
    Dakkak M, Bennett JR (1992) A new dysphagia score with objective validation. J Clin Gastroenterol 14:99–100CrossRefGoogle Scholar
  13. 13.
    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL (1996) A penetration-aspiration scale. Dysphagia 11:93–98CrossRefGoogle Scholar
  14. 14.
    Lam L, Samman N (2013) Speech and swallowing following tongue cancer surgery and free flap reconstruction–a systematic review. Oral Oncol 49:507–524CrossRefGoogle Scholar
  15. 15.
    Ji YB, Cho YH, Song CM et al (2017) Long-term functional outcomes after resection of tongue cancer: determining the optimal reconstruction method. Eur Arch Otorhinolaryngol 274:3751–3756CrossRefGoogle Scholar
  16. 16.
    Brown JS, Rogers SN, Lowe D (2006) A comparison of tongue and soft palate squamous cell carcinoma treated by primary surgery in terms of survival and quality of life outcomes. Int J Oral Maxillofac Surg 35:208–214CrossRefGoogle Scholar
  17. 17.
    FM MC, Pauloski BR, Logemann JA, Rademaker AW, Colangelo L, Shedd D et al (1998) Functional results of primary closure vs flaps in oropharyngeal reconstruction: a prospective study of speech and swallowing. Arch Otolaryngol Head Neck Surg 124:625–630CrossRefGoogle Scholar
  18. 18.
    Urken ML, Biller HF (1994) A new bilobed design for the sensate radial forearm flap to preserve tongue mobility following significant glossectomy. Arch Otolaryngol Head Neck Surg 120:26–31CrossRefGoogle Scholar
  19. 19.
    Akashi M, Hashikawa K, Sakakibara A, Komori T, Terashi H (2015) Long-term follow-up study of radial forearm free flap reconstruction after hemiglossectomy. J Craniofac Surg 26:44–47CrossRefGoogle Scholar
  20. 20.
    Bianchi B, Ferri A, Ferrari S, Copelli C, Boni P, Ferri T et al (2012) The free anterolateral thigh musculocutaneous flap for head and neck reconstruction: one surgeon’s experience in 92 cases. Microsurgery 32:87–95CrossRefGoogle Scholar
  21. 21.
    Van Lierop AC, Fagan JJ (2008) Buccinator myomucosal flap: clinical results and review of anatomy, surgical technique and applications. J Laryngol Otol 122:181–187CrossRefGoogle Scholar
  22. 22.
    Pribaz J, Stephens W, Crespo L, Gifford G (1992) A new intraoral flap: facial artery musculomucosal (FAMM) flap. Plast Reconstr Surg 90:421–429CrossRefGoogle Scholar
  23. 23.
    Cherubino M, Berli J, Turri-Zanoni M et al (2017) Sandwich fascial anterolateral thigh flap in head and neck reconstruction: evolution or revolution? Plast Reconstr Surg Glob Open 5:e1197CrossRefGoogle Scholar
  24. 24.
    Brierley J, Gospodarowicz M, Wittekind C (2017) UICC TNM classification of malignant tumours, 8th edn. Wiley, ChichesterGoogle Scholar
  25. 25.
    Huang SH, O’Sullivan B (2017) Overview of the 8th edition TNM classification for head and neck cancer. Curr Treat Options in Oncol 18:40CrossRefGoogle Scholar
  26. 26.
    Dzioba A, Aalto D, Papadopoulos-Nydam G et al (2017) Functional and quality of life outcomes after partial glossectomy: a multi-institutional longitudinal study of the head and neck research network. Otolaryngol Head Neck Surg 46:1–11CrossRefGoogle Scholar
  27. 27.
    Molteni G, Molinari G, Ghirelli M, Presutti L (2019) Microvascular reconstruction two years after subtotal glossectomy: is it worth it? J Stomatol Oral Maxillofac Surg 120:49–54CrossRefGoogle Scholar
  28. 28.
    Onoda S, Kimata Y, Sugiyama N, Onoda T, Mizukawa N (2014) Secondary head and neck reconstruction using the free flap to improve the postoperative function or appearance of cancer survivors. Microsurgery 34:122–128CrossRefGoogle Scholar
  29. 29.
    Canis M, Weiss BG, Ihler F, Hummers-Pradier E, Matthias C, Wolff HA (2016) Quality of life in patients after resection of pT3 lateral tongue carcinoma: microvascular reconstruction versus primary closure. Head Neck 38:89–94CrossRefGoogle Scholar
  30. 30.
    Brown L, Rieger JM, Harris J, Seikaly H (2010) A longitudinal study of functional outcomes after surgical resection and microvascular reconstruction for oral cancer: tongue mobility and swallowing function. J Oral Maxillofac Surg 68:2690–2700CrossRefGoogle Scholar
  31. 31.
    Li X, Sun Q, Guo S (2016) Functional assessments in patients undergoing radial forearm flap following hemiglossectomy. J Craniofac Surg 27:172–175CrossRefGoogle Scholar
  32. 32.
    Uwiera T, Seikaly H, Rieger J, Chau J, Harris JR (2004) Functional outcomes after hemiglossectomy and reconstruction with a bilobed radial forearm free flap. J Otolaryngol 33:356–359CrossRefGoogle Scholar
  33. 33.
    Loewen IJ, Boliek CA, Harris J, Seikaly H, Rieger JM (2010) Oral sensation and function: a comparison of patients with innervated radial forearm free flap reconstruction to healthy matched controls. Head Neck 32:85–95PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Otorhinolaryngology Head and Neck Surgery, Department of Surgery, Dentistry, Paediatrics and GynaecologyUniversity Hospital of VeronaBorgo TrentoItaly
  2. 2.Department of Otorhinolaryngology - Head and Neck SurgeryUniversity Hospital of ModenaModenaItaly
  3. 3.Department of Medical and Surgical Sciences for Children and AdultsUniversity of Modena and Reggio EmiliaModenaItaly

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