Jana Rieger

A Longitudinal Study of Functional Outcomes After Surgical Resection and Microvascular Reconstruction for Oral Cancer: Tongue Mobility and Swallowing Function

PURPOSEnControversy exists regarding physiologic outcomes related to the tongue after radial forearm free flap (RFFF) reconstruction of hemiglossectomy defects. The purpose of this study is to report swallowing and tongue mobility outcomes for patients with RFFF reconstruction of the anterior two thirds of the tongue.nnnMATERIALS AND METHODSnSwallowing and tongue mobility were assessed at 4 different time points over the course of 1 year of treatment for 15 patients who underwent RFFF reconstruction of the anterior two thirds of the tongue. Preoperative swallowing function in the treatment group was compared with a patient group that had no involvement of the tongue. A comparison group of 14 patients with nasopharyngeal cancer was used to compare preintervention function in patients with and without lesions of the tongue.nnnRESULTSnNo differences existed between the experimental and comparison groups before intervention. Two significant differences were found for swallowing ability and tongue mobility in the experimental group. Some of the measures at 1 month postoperatively were significantly different from some of the preoperative measures for liquid swallows and posterior-tongue mobility. All measures returned to baseline by the studys end.nnnCONCLUSIONnAlthough some minor deficits exist in swallowing and tongue mobility after RFFF reconstruction, it appears that these problems are no longer evident 12 months postoperatively.

Current Strategies in Reconstruction of Maxillectomy Defects

OBJECTIVEnTo outline a contemporary review of defect classification and reconstructive options.nnnDESIGNnReview article.nnnSETTINGnTertiary care referral centers.nnnRESULTSnAlthough prosthetic rehabilitation remains the standard of care in many institutions, the discomfort of wearing, removing, and cleaning a prosthesis; the inability to retain a prosthesis in large defects; and the frequent need for readjustments often limit the value of this cost-effective and successful method of restoring speech and mastication. However, flap reconstruction offers an option for many, although there is no agreement as to which techniques should be used for optimal reconstruction. Flap reconstruction also involves a longer recovery time with increased risk of surgical complications, has higher costs associated with the procedure, and requires access to a highly experienced surgeon.nnnCONCLUSIONnThe surgeon and reconstructive team must make individualized decisions based on the extent of the maxillectomy defect (eg, the resection of the infraorbital rim, the extent of palate excision, skin compromise) and the need for radiation therapy.

Social perception of speech in individuals with oropharyngeal reconstruction.

Abstract Oral cancer affects approximately 5% of the Canadian population every year. One option for treatment of oropharyngeal cancer includes resection of the diseased tissue with primary reconstruction of the defect using a microvascular free flap, followed by post-operative adjuvant radiation therapy. The aim of reconstructive surgery is to maintain functional speech and swallowing. While the literature provides support for the maintenance of speech intelligibility following reconstructive procedures, certain aspects of resonance may be altered when the palatal structures are involved. Little is known about the effect of such alterations on the perception of speakers who have been treated with microvascular free flap reconstruction. Social perception is a process in which we infer attributes of others, with the speech signal playing an integral part in attribution. The purpose of this study was to explore the social perceptions formed about speakers both before and after surgery for oropharyngeal cancer. The results of this study revealed that positive perceptions of speakers significantly diminished as a result of surgery and negative perceptions increased. Certain variables, such as degree of resection of the soft palate and base of tongue, and sex of the speaker, had influence on the results. This research suggests that intelligibility measurements of speech, although useful, do not provide a complete indication of the social impact of reconstructive surgery on patients with oropharyngeal resections.

The lip-splitting mandibulotomy: Aesthetic and functional outcomes

To determine the aesthetic and functional outcomes of the most invasive approach to oral cavity/oropharyngeal lesions, the lip-splitting mandibulotomy approach (LSMA), versus the least invasive, the trans-oral approach (TOA). Retrospective paired-cohort study. Thirty-six patients with oral/oropharyngeal cancers treated with primary surgical extirpation, bilateral neck dissections and adjuvant radiation therapy were enrolled. Half underwent LSMA and half TOA. Patients were paired into gender, age and follow-up time matched cohorts. The primary outcome measure was overall patient satisfaction with scar cosmesis assessed with a 10-point Likert scale. Clinician and naïve viewer ratings of disfigurement in addition to the validated Vancouver scar scale (VSS) and patient and observer scar assessment scale (POSAS) were completed. Functional outcomes included lower-lip sensation and movement as well as oral continence assessment. LSMA patients had very high satisfaction and low perceptions of disfigurement with no statistically significant differences between cohorts (p>.05). VSS and POSAS results failed to demonstrate significant differences between groups (p>.05). Naïve observers, however, found the LSMA to be more disfiguring than TOA scars (p=.03). No significant differences in lower-lip sensation to touch, two-point discrimination or temperature distinction were found (p>.05). House-Brackman and movement symmetry scores were significantly indifferent between cohorts (p>.05). Video-fluoroscopic swallowing studies showed no difference in oral continence between cohorts (p>.05). The LSMA provides satisfactory scarring and low self-perception of disfigurement for patients. Moreover, the LSMA does not impact lower-lip sensation, movement or oral continence.

Correction to: Functional and quality of life outcomes after partial glossectomy: a multi-institutional longitudinal study of the head and neck research network

BackgroundWhile aggressive treatment for oral cancer may optimize survival, decrements in speech and swallowing function and quality of life often result. This exploratory study investigated how patients recover their communicative function, swallowing ability, and quality of life after primary surgery [with or without adjuvant (chemo)radiation therapy] for tongue cancer over the course of the first year post-operation.MethodsPatients treated for oral cancer at three institutions (University of Alberta Hospital, Mount Sinai Beth Israel Medical Center, and Turku University Hospital) were administered patient-reported outcomes assessing speech [Speech Handicap Index (SHI)], swallowing [(M.D. Anderson Dysphagia Inventory (MDADI)] and quality of life [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC-H&N35)]. Outcome measures were completed pre-operatively and at 1-, 6-, and 12-months post-operatively.ResultsOne hundred and seventeen patients undergoing partial glossectomy with reconstruction participated in this study. Results indicated no significant differences in swallowing function (MDADI and EORTC-H&N35 subscales) between baseline and 6xa0months post-surgery and no significant differences in speech function (SHI subscales) between baseline and 1xa0year post-surgery. Most quality of life domains (EORTC-H&N35 subscales) returned to baseline levels by 1xa0year post-operation, while difficulties with dry mouth and sticky saliva persisted. A clear time trend of adjuvant (chemo)radiation therapy negatively affecting dry mouth scores over time was identified in this study, while negative independent effects of chemoradiation on MDADI swallowing, and EORTC-H&N35 swallowing, eating, and opening mouth subscales were found.ConclusionsAssessment time influenced patient-reported speech, swallowing, and quality of life outcomes, while treatment (by time) effects were found for only swallowing and quality of life outcomes. Results of the present study will help guide clinical care and will be useful for patient counseling on expected short and long-term functional and quality of life outcomes of surgical and adjuvant treatment for oral cavity cancer.

P080 Soft Palate Reconstruction Using the CAP Modification of the Radial Forearm Flap: An Assessment of Functional Outcomes

a mild and well-tolerated grade of chronic aspiration that does not require a nothing-by-mouth status. Design: Cohort study. The follow-up period ranged from 3 to 13 years. Setting: Referral medical center. Patients: One hundred sixteen consecutive patients (mean age, 67 years) treated with supracricoid partial laryngectomy were analyzed. The patients included in the study were showed no evidence of disease, followed up for more than 3 years, were without tracheal cannulae and nasogastric tubes, and were able to eat by mouth. Twenty patients with chronic obstructive pulmonary disease and normal deglutition made up the control group. Intervention: Evaluation of postoperative swallowing disorders included a careful observation of the patients by the physician, fiberoptic endoscopic evaluation of swallowing, and videofluoroscopy. Main Outcomes Measure: Clinical grading of postoperative aspiration was assessed according to the Leipzig and Pearson scale. Radiologic manifestations of chronic aspiration were recorded using high-resolution computed tomographic scans. Results: Higher incidences of bronchiectasis, lung cystis, and alveolar septal thickness were found in the patients affected by postoperative dysphagia compared with the control group. No significant differences were noted between the groups with reference to the remaining radiologic findings. Conclusion: Supracricoid partial laryngectomy causes a mild and well-tolerated grade of dysphagia that does not require a nothing-by-mouth status. Patients with chronic aspiration showed pulmonary conditions similar to patients with chronic obstructive pulmonary disease.