A Comparison of Three Methods of Oral Reconstruction

Abstract

\s=b\A protocol is presented that was designed to provide comparative data on the two primary oral cavity functions affected by surgery: speech and swallowing. Three types of reconstruction (skin grafts, hemitongue flaps, and myocutaneous flaps) and results of a series of tests given to 15 surgical patients with T2 and T3 tongue and/or floor of mouth lesions were evaluated. The patients who had split-thickness skin grafts had the best oral function results. The study suggests that tongue mobility is the most significant variable in determining postoperative speech results. (Arch Otolaryngol Head Neck Surg 1987;113:496-500) The major objective of oral cavity reconstruction is the restoration of preoperative speech and degluti¬ tion. While there are numerous arti¬ cles reporting different methods of oral cavity reconstruction, there are few that present comparative data on the effects that different reconstruc¬ tive approaches have on oral cavity function. LaFerriere et al1 reported postoperative speech and deglutition results in their analysis of skin graft application in composite resections.Logemann and BytelP provided objec¬ tive evaluation of three methods of tongue closure in oral cavity recon¬ structions. Before a meaningful reha¬ bilitative assessment of different reconstructive methods can be made, the affected functions, speech and swallowing, must be measured in a meaningful manner to allow for com¬ parison of results.In the past, the head and neck sur¬ geon's prime concern in reconstruc¬ tion of the oral cavity after ablative surgery has been to close the wound with the least amount of morbidity. Wound closure, in many instances, took priority over functional consider¬ ations. This was partially due to the limited number of reconstructive options available. Currently, however, a number of alternatives are available to reconstruct an oral cavity defect in a single stage, ie, skin graft, tongue flap, local flap, regional flap, myocu¬ taneous flap, or free flap. But without any meaningful objective data on how the methods affect function, the deci¬ sion is based on the surgeon's prefer¬ ence. To date, no clinical protocol has been devised to provide comparative functional data.The purpose of this study was to determine if meaningful, comparative data could be obtained from testing postoperative speech and swallowing in patients who were treated for oral cavity cancer. The speech parameters measured included intelligibility, tongue mobility, diadochokinetic rate, and articulation. An index of oral deglutition called the chew/swallow index was also assessed. PATIENTS AND METHODSThe charts of 212 patients with oral cavity cancer who were treated between Jan 1, 1976, and Dec 31, 1981, at Emory University, Atlanta, and associated hospi¬ tals (Veterans Administration Medical Center, Grady Memorial Hospital, and Crawford-Long Hospital, Atlanta) were reviewed. Patients who had T2-T3 oral tongue lesions and/or floor of mouth lesions were selected (Table 1). A limited number of patients who had undergone a later...

A comparison of masticatory function in patients with or without reconstruction of the mandible

“…This variability is due to the individual variation in tongue volume, tongue sensation, and tongue mobility. Tongue volume, 19 sensation, 3,20 and mobility 3,21 have been considered important to masticatory function, yet a systematic investigation of head and neck cancer patients that specifically assesses tongue function Normals had significantly higher molar and incisal biting force than did both reconstructed and nonreconstructed patients (p < .001). Significant differences were seen between all three groups with regard to tongue function (p < .002).…”

Quality of Life for Patients Following Total Laryngectomy vs Chemoradiation for Laryngeal Preservation

“…[14][15][16][17] In the last few years, a number of better-validated, more comprehensive healthrelated QOL instruments have become available to assess the impact of illness on the overall QOL of patients.…”

Swallowing Function in Patients Who Underwent Hemiglossectomy: Comparison of Primary Closure and Free Radial Forearm Flap Reconstruction With Videofluoroscopy

“…The use of remaining tongue tissue to close the defect further reduced the amount of functional tongue and increased disability. 4,5,11 Patients with primary closure of the defect usually have a small but freely movable tongue. This excellent mobility of the remaining tongue allows the patient to have good speech.…”