Functional Assessments in Patients Undergoing Radial Forearm Flap Following Hemiglossectomy

Abstract

Our goal was to evaluate the functional outcomes following radial forearm free-flap reconstruction with a focus on radiotherapy. A 2-year prospective study was performed. A total of 47 patients were enrolled finally. They were asked to complete the swallowing, chewing, speech domains of the University of Washington Quality of Life questionnaire preoperatively and at 2 years postoperatively. Swallowing capacity was apparently affected after surgery, but no patients reported there was chokes cough during eating, the mean score was 51.1 (SD: 21.3). Most patients (70.2%) presented their articulation was good enough for everyday life, and the mean score was 60.0 (SD: 21.1). As for chewing, only 7 (14.9%) patients complained there was negative effect, and the mean score was as high as 92.6 (SD: 18.0). Compared to patients with surgery only, patients with postoperative radiotherapy only had significantly worse swallowing and speech capacity. Compared with patients with postoperative radiotherapy only, patients with both preoperative and postoperative radiotherapy tended to have better swallowing and speech. No significant differences were found between chewing and radiotherapy. In most patients, the results of swallowing, speech, and chewing are favorable. Postoperative radiotherapy has an apparent impact on functional impairment, but preoperative tends to preserve the original tongue function.

Compartmental Surgery for Oral Tongue Cancer: Objective and Subjective Functional Evaluation

“…Overall, the most important variables influencing deglutition were adjuvant treatment, age, gender, oropharyngeal resection, and type of free flap employed, as previously reported in literature 19–23 . Performing functional evaluation at 6 and 12 months showed that it is reasonable to expect some improvements up to 1 year after surgery, as also confirmed by other studies 24–27 .…”

“…Overall, the most important variables influencing deglutition were adjuvant treatment, age, gender, oropharyngeal resection, and type of free flap employed, as previously reported in literature. [19][20][21][22][23] Performing functional evaluation at 6 and 12 months showed that it is reasonable to expect some improvements up to 1 year after surgery, as also confirmed by other studies. [24][25][26][27] It is interesting to note how at 1 year after treatment patients' subjective perception of swallowing is generally reported as good/satisfactory in more than 50% of cases using both the EORTC and UWQOL questionnaires.…”

A Head-to-Head Comparison of the Medial Sural Artery Perforator versus Radial Forearm Flap for Tongue Reconstruction

“…16,17 However, the RFF and ALT do come with significant drawbacks. [18][19][20][21] The main limitations of the RFF include (1) sacrifice of major upper limb vessels and risk of nerve injury causing numbness, 4,22,23 (2) requirement for skin grafting for donor-site closure with subsequent risk of partial graft loss, poor scarring, and dyspigmentation, 22,23 (3) lack of bulk of the neotongue, which is decreased further with shrinkage following radiotherapy, 24,25 and (4) cosmetically unfavorable scar. 2,23,26,27 The ALT alternative is commonly too thick for partial glossectomy defects which can cause food retention and speech unintelligibility, necessitating additional debulking.…”

Systematic review of postoperative therapy for resected squamous cell carcinoma of the head and neck: Executive summary of the American Radium Society appropriate use criteria

“…92 A singlerandomized trial studied the effect of radiation to normal tissue and observer-rated mucositis. 94 The remaining studies either included patient-questionnaire endpoints [95][96][97][98][99][100][101][103][104][105][106]109,110,113,115 or observer-rated measurements of head and shoulder mobility, 102 video fluoroscopy and speech assessment using standardized testing, 107 lymphedema and fibrosis measurement, 108 oral bite force and masticatory function, 111 tongue sensation and mobility 112 and maximal mouth opening. 114…”

“…The randomized trials are presented in Table 4. Studies that focused on non‐oncologic endpoints are shown in the Table S2 and included two systematic reviews, 92,93 one randomized trial, 94 and 21 non‐randomized clinical trials 95‐115 . All studies reported staging prior to the implementation of AJCC‐8.…”