Analysis of Speech and Functional Outcomes in Tongue Reconstruction after Hemiglossectomy

Abstract

Background Reconstruction in tongue cancer to restore the shape and function of the tongue without airway obstruction in the narrow oral cavity is challenging for reconstructive surgeons. Herein, the authors retrospectively analyzed flaps to reveal the factors that affect the functional outcome of tongue reconstruction.

Methods Herein, we retrospectively reviewed 30 patients (men, 16; women, 14; mean age, 50.3 years) who underwent the hemi-tongue reconstruction followed by speech therapy between 2009 and 2017. Data about postoperative chemotherapy and radiotherapy were collected. The dimensions (width and length) of the flaps were measured. Speech outcomes were assessed under the conditions of varying distances of the tongue tip from lower incisors when it was protruded, retracted, and elevated. Lateralization was evaluated based on the count of teeth reached by the tip of the tongue from the midline.

Results Preoperative chemotherapy and radiotherapy significantly influenced tongue retraction, tongue articulation, and intelligibility (p = 0.006, 0.002, 0.048, respectively). Postoperative chemotherapy did not statistically significantly influence any outcome measure. Contralateralization of the tongue was significantly decreased in the postoperative radiotherapy group (p = 0.029). The length of the flap showed highly negative correlation with articulation and intelligibility (p = 0.009, p< 0.001, respectively). The width of the flap was not correlated with the outcomes.

Conclusion We proved that unlike chemotherapy, postoperative radiotherapy influences the functional outcome of tongue reconstruction. The dimensions, particularly the length of the flap, were also important for restoring the reconstructed tongue function.

Keywords

speech - tongue - reconstructive surgical procedures

• References

• 1 Engel H, Huang JJ, Lin CY. , et al. A strategic approach for tongue reconstruction to achieve predictable and improved functional and aesthetic outcomes. Plast Reconstr Surg 2010; 126 (06) 1967-1977
• 2 Laaksonen JP, Rieger J, Harris J, Seikaly H. A longitudinal acoustic study of the effects of the radial forearm free flap reconstruction on sibilants produced by tongue cancer patients. Clin Linguist Phon 2011; 25 (04) 253-264
• 3 Baas M, Duraku LS, Corten EM, Mureau MA. A systematic review on the sensory reinnervation of free flaps for tongue reconstruction: Does improved sensibility imply functional benefits?. J Plast Reconstr Aesthet Surg 2015; 68 (08) 1025-1035
• 4 Brown L, Rieger JM, Harris J, Seikaly H. A longitudinal study of functional outcomes after surgical resection and microvascular reconstruction for oral cancer: tongue mobility and swallowing function. J Oral Maxillofac Surg 2010; 68 (11) 2690-2700
• 5 Matsui Y, Ohno K, Yamashita Y, Takahashi K. Factors influencing postoperative speech function of tongue cancer patients following reconstruction with fasciocutaneous/myocutaneous flaps--a multicenter study. Int J Oral Maxillofac Surg 2007; 36 (07) 601-609
• 6 Bodin IK, Lind MG, Arnander C. Free radial forearm flap reconstruction in surgery of the oral cavity and pharynx: surgical complications, impairment of speech and swallowing. Clin Otolaryngol Allied Sci 1994; 19 (01) 28-34
• 7 Hara I, Gellrich NC, Duker J. , et al. Swallowing and speech function after intraoral soft tissue reconstruction with lateral upper arm free flap and radial forearm free flap. Br J Oral Maxillofac Surg 2003; 41 (03) 161-169
• 8 Jacobson MC, Franssen E, Fliss DM, Birt BD, Gilbert RW. Free forearm flap in oral reconstruction. Functional outcome. Arch Otolaryngol Head Neck Surg 1995; 121 (09) 959-964
• 9 Michiwaki Y, Schmelzeisen R, Hacki T, Michi K. Articulatory function in glossectomized patients with immediate reconstruction using a free jejunum flap. J Craniomaxillofac Surg 1992; 20 (05) 203-210
• 10 Nicoletti G, Soutar DS, Jackson MS, Wrench AA, Robertson G, Robertson C. Objective assessment of speech after surgical treatment for oral cancer: experience from 196 selected cases. Plast Reconstr Surg 2004; 113 (01) 114-125
• 11 Schliephake H, Schmelzeisen R, Schönweiler R, Schneller T, Altenbernd C. Speech, deglutition and life quality after intraoral tumour resection. A prospective study. Int J Oral Maxillofac Surg 1998; 27 (02) 99-105
• 12 Manrique OJ, Leland HA, Langevin CJ. , et al. Optimizing outcomes following total and subtotal tongue reconstruction: A systematic review of the contemporary literature. J Reconstr Microsurg 2017; 33 (02) 103-111
• 13 Ehrl D, Heidekrueger PI, Ninkovic M, Broer PN. Effect of preoperative medical status on microsurgical free flap reconstructions: a matched cohort analysis of 969 cases. J Reconstr Microsurg 2018; 34 (03) 170-175
• 14 Smiljanic R, Gilbert RC. Intelligibility of noise-adapted and clear speech in child, young adult, and older adult talkers. J Speech Lang Hear Res 2017; 60 (11) 3069-3080
• 15 Cerny L, Vokral J, Dlouha O. Influence of age on speech intelligibility in babble noise. Acta Neurobiol Exp (Wars) 2018; 78 (02) 140-147
• 16 Mueller CK, Schultze-Mosgau S. Radiation-induced microenvironments--the molecular basis for free flap complications in the pre-irradiated field?. Radiother Oncol 2009; 93 (03) 581-585
• 17 Riot S, Herlin C, Mojallal A. , et al. A systematic review and meta-analysis of double venous anastomosis in free flaps. Plast Reconstr Surg 2015; 136 (06) 1299-1311
• 18 Lee YC, Chen WC, Chen SH. , et al. One versus two venous anastomoses in anterolateral thigh flap reconstruction after oral cancer ablation. Plast Reconstr Surg 2016; 138 (02) 481-489
• 19 Khaja SF, Rubin N, Bayon R. Venous complications in one versus two vein anastomoses in head and neck free flaps. Ann Otol Rhinol Laryngol 2017; 126 (10) 722-726
• 20 Grinsell D, Yue BY. The functional free innervated medial gastrocnemius flap. J Reconstr Microsurg 2014; 30 (07) 451-456