Total glossolaryngectomy cohort study (N = 25): Survival, function and quality of life

Kamhieh, Yasmine; Fox, Hannah; Healy, S; Hallett, E; Quine, S. M.; Owens, David M.; Tomkinson, Alun; Thomas, C.; Smith, Don; Ingrams, Duncan R.; Passant, C; Pope, L; Marnane, Conor; Berry, Sandeep

doi:10.1111/coa.13121

Cited by 6 publications

(7 citation statements)

References 9 publications

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“…Although investigators select various flaps, the shape of the reconstructed oropharynx is uniformly described as “funneled” with a “downward slope” to maximize the effect of gravity for effective swallowing . However, the previously proposed reconstruction methods did not achieve complete oral intake without the assistance of a feeding tube in all patients . In the largest series of TGL cases to date, only 26% of the 25 patients recovered complete oral intake.…”

Section: Discussionmentioning

confidence: 99%

“…In the largest series of TGL cases to date, only 26% of the 25 patients recovered complete oral intake. Furthermore, over half of the patients could only swallow liquids …”

Section: Discussionmentioning

confidence: 99%

“…Total glossolaryngectomy (TGL) for treatment of advanced laryngeal or tongue cancers is a devastating surgery that deprives patients of their voice and sense of taste. Although aspiration‐free oral intake is possible after surgery, postoperative swallowing function is not always satisfactory . Reports indicate that 20%‐89% of patients achieve complete oral intake without the assistance of a feeding tube …”

Section: Introductionmentioning

confidence: 99%

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Pharyngeal reconstruction by anterolateral thigh flap with vastus lateralis muscle transfer for effective swallowing after total glossolaryngectomy: A case report

et al. 2019

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Background: We report a novel reconstruction technique that maintained effective swallowing after total glossolaryngectomy (TGL) by restoring pharyngeal constriction using a vascularized vastus lateralis muscle transfer. Methods: A 65-year-old male with recurrent tongue cancer underwent TGL and anterolateral thigh flap reconstruction with the vastus lateralis muscle. The bilateral cut ends of the remaining posterior pharyngeal wall constrictor muscle were sutured to the transferred vastus lateralis muscle so that the two muscles encircled the reconstructed pharynx. The femoral nerve of the vastus lateralis muscle was coapted to the hypoglossal nerve. Results: Videofluorographic examination showed the contrast bolus flowing smoothly with little assistance from gravity. Laryngoscopic examination showed circumferential constriction of the reconstructed pharynx. The patient could swallow soft food without placing the bolus in his posterior oral cavity or drinking simultaneously. Conclusion: The restoration of pharyngeal constriction introduces the possibility of functional swallowing in patients after TGL. K E Y W O R D S anterolateral thigh flap, functional swallowing, pharyngeal constrictor muscle, total glossolaryngectomy, vastus lateralis muscle transfer

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Section: Discussionmentioning

confidence: 99%

“…In the largest series of TGL cases to date, only 26% of the 25 patients recovered complete oral intake. Furthermore, over half of the patients could only swallow liquids …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pharyngeal reconstruction by anterolateral thigh flap with vastus lateralis muscle transfer for effective swallowing after total glossolaryngectomy: A case report

et al. 2019

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“…Some patients are unable to meet their nutritional needs through oral intake alone after the procedure. [1][2][3] To date, few authors have described reconstruction methods after total glossolaryngectomy, and they uniformly considered postoperative swallowing to be mainly dependent on gravity. [4][5][6] However, swallowing function after total glossolaryngectomy has not been evaluated thoroughly.…”

mentioning

confidence: 99%

“…Some patients are unable to meet their nutritional needs through oral intake alone after the procedure. 1–3…”

mentioning

confidence: 99%

“Videofluorographic analysis of swallowing function after total glossolaryngectomy.”

Kadota

Shimamoto

Fukushima

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Summary: Surgeons have traditionally believed that swallowing is mainly dependent on gravity after total glossolaryngectomy. However, swallowing function after total glossolaryngectomy varies widely among patients, and a thorough analysis is lacking. The authors aimed to clarify the swallowing function after total glossolaryngectomy and determine whether it is primarily dependent on gravity. The authors retrospectively analyzed videofluorographic examinations of patients who underwent total glossolaryngectomy and free or pedicle flap reconstruction. The authors enrolled 20 patients (12 male; mean age, 61 years; age range, 43 to 89 years). All patients demonstrated constriction of the reconstructed pharynx to some degree, and no patient’s ability to swallow was dependent on gravity alone. Videofluorography showed excellent barium clearance in eight patients and poor clearance in 12. All patients with excellent clearance showed strong constriction of the posterior pharyngeal wall, whereas only 8.3 percent of the patients with poor clearance showed adequate constriction, which was significantly different (p = 0.0007). Velopharyngeal closure and lip closure also contributed significantly to excellent clearance (p = 0.041). The shape of the reconstructed pharynx (depressed, flat, protuberant) showed no statistically significant association with excellent clearance. Contrary to previous understanding, constriction of the remnant posterior pharyngeal wall played an important role in swallowing after total glossolaryngectomy, and gravity played a secondary role. Dynamic posterior pharyngeal wall movement might result from the increased power of the pharyngeal constrictor muscle and compensate for the immobility of the transferred flap. A well-functioning pharyngeal constrictor muscle and complete velopharyngeal and lip closures can contribute to excellent barium clearance in patients after total glossolaryngectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Survival, functional, and quality of life outcomes between total glossectomy with and without total laryngectomy: A narrative review

Burnham

Ottenstein

Boyce

et al. 2022

American Journal of Otolaryngology

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Total glossolaryngectomy cohort study (N = 25): Survival, function and quality of life

Cited by 6 publications

References 9 publications

Pharyngeal reconstruction by anterolateral thigh flap with vastus lateralis muscle transfer for effective swallowing after total glossolaryngectomy: A case report

Pharyngeal reconstruction by anterolateral thigh flap with vastus lateralis muscle transfer for effective swallowing after total glossolaryngectomy: A case report

“Videofluorographic analysis of swallowing function after total glossolaryngectomy.”

Survival, functional, and quality of life outcomes between total glossectomy with and without total laryngectomy: A narrative review

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