The relationship between lingual and hypoglossal nerve function and quality of life in head and neck cancer

Abstract

Sensorimotor impairment of the tongue has the potential to affect speech and swallowing. The purpose of this study was to critically examine the effects of nerve preservation and reinnervation after reconstruction of the base of tongue on patient-perceived outcomes of quality of life (QoL) related to speech and swallowing through completion of the EORTC QLQ-H&N35 standardised questionnaire. Thirty participants with a diagnosis of base of tongue cancer underwent primary resection and reconstruction with a radial forearm free flap, which may or may not have included nerve repair to the lingual nerve, hypoglossal nerve or both. Eight QoL domains sensitive to changes in motor and sensory nerve function were included in the analysis. Transected lingual and hypoglossal nerves were associated with difficulty in swallowing, social eating, dry mouth and social contact. There were fewer problems reported when these nerves were either repaired or left intact. There were no significant differences between patient nerve status and QoL outcomes for speech, sticky saliva and use of feeding tubes. This study was the first to examine the impact of sensory or motor nerve transection and reconstruction on health-related QoL outcomes.

Functional outcomes of sensate versus insensate free flap reconstruction in oral and oropharyngeal reconstruction: A systematic review

“…Patients with normal upper aerodigestive tract anatomy and biomechanics may be able to masticate and swallow with their entire upper aerodigestive tract anesthetized, patients who have undergone surgery for head and neck cancer may rely on sensation in order to compensate for altered anatomy and biomechanics. A study by Elfring et al found that patients with repaired/intact hypoglossal and/or lingual nerves had significantly better social contact, social eating, swallowing, and dry mouth scores after oropharyngeal resection and reconstruction, however, it is not discussed in detail here because it did not include a comparison between sensate and insensate.…”

“…Studies using subjective measures rely on data, such as patient satisfaction and quality of life surveys administered at various points throughout the postoperative course, as well as subjective measurements of speech intelligibility . For other measures, a listener most commonly subjectively rated speech outcomes utilizing scales, such as unintelligible speech to normal intelligible speech .…”

“…Swallowing outcomes were most commonly measured by subjective patient satisfaction with swallowing function. Some of the studies had the patients rank their swallowing using scales, such as very difficult to normal . In other studies, swallowing outcomes were subjectively ranked using scales, such as severe dysphagia to normal deglutition or based on diet limitations (tube feed dependence, pureed foods, soft foods, or no limitations) …”

“…The 1980s and 1990s saw the description of many novel free flaps, such as the fibular osteocutaneous, scapular and parascapular fasciocutaneous, and osteofasciocutaneous, fasciocutaneous, and osteocutaneous radial forearm free flaps (RFFFs) . With a robust and expanding versatile armamentarium of head and neck reconstructive techniques, the goals of surgery transitioned from simple closure of the defect to maintenance of swallowing, speaking, and confidence in social interactions …”

A systematic review on the sensory reinnervation of free flaps for tongue reconstruction: Does improved sensibility imply functional benefits?

“…Impairment of tongue function can severely affect quality of life. 1 Therefore, it is paramount to restore the tongue's main function after oncologic (hemi)glossectomy. Because of its complex anatomy, it is challenging to restore bulk, mobility, and sensibility in order for the reconstructed tongue to be functional.…”