Improving the Swallowing in Total Glossectomy With Laryngeal Preservation

Abstract

This study aims to evaluate the parameters that might have an impact on swallowing performance after a total glossectomy with laryngeal preservation (TGLP). Methods: Among 39 patients who underwent surgery with curative intent for squamous cell carcinoma of the tongue, our retrospective analysis focused on 18 patients treated by TGLP and flap reconstruction. The flap was positioned using three points of suspension: mandible (anteriorly), remaining suspensor muscles (cranially), and hyoid bone (inferiorly). Videofluoroscopic swallowing studies were performed after surgery, and the movements of the hyoid bone on the horizontal and vertical plane were measured on a frame-by-frame basis, and the velopharyngeal contact was recorded. Swallowing was studied at consecutive time-intervals using the Gugging Swallowing Screen (GUSS), and patients were categorized into three groups according to their swallowing ability (good, intermediate, and bad). The relationship between categorical and continuous variables and the swallowing ability were investigated using the chi-squared or Fischer exact test and Mann-Whitney test or t-student test respectively. Results: Swallowing ability at 6-8 months was good in 13 patients and intermediate or bad in five patients. Swallowing improved in 1 and 3 patients at 12 and 18 months, respectively. The hyoid bone movement in the y-axis and extension of surgery to the tonsil were statistically associated with swallowing (P=0.002 and P=0.04, respectively). Velopharyngeal contact was obtained in the entire cohort. Conclusions: Flap suspension using three points of attachment, could allow the restoration of an active hyoid movement and the velopharyngeal closure, thereby achieving valid swallowing.

Advances in oral tongue reconstruction: a reconstructive paradigm and review of functional outcomes

“…The authors proposed the use of three-point suspension during reconstruction with preservation of hyoid elevation. However, only one patient in the series was reconstructed with an ALT free flap and rates of aspiration, pneumonia, and gastrostomy tube use were not reported [22].…”