Functional Results of Tongue Reconstruction Using Free Flaps after Total Glossectomy

Sun, Dong Il; Kim, Min Sik; Lee, Jeong Hak; Jeon, Jin Ha; Song, Chi Jun; Cho, Seung Ho

Abstract

BACKGROUND AND OBJECTIVES: Total glossectomy and postoperative radiotherapy is the treatment of choice for advanced carcinoma of the floor of mouth and tongue. But, it has the potential for causing severe speech impairment and disrupting the deglutition and may cause life-threatening aspiration. Proper reconstruction is essential for the postoperative functional rehabilitation. The aim of the present study is to evaluate the oncologic results and the results of speech and swallowing function tests in patients who were reconstructed using surgical flaps after total glossectomy.
MATERIALS AND METHODS
We reviewed the medical records of 7 patients who underwent total glossectomy (Jul. 1995 to Feb. 2000). Modified barium swallow (MRS) according to Longmann's method was done in 5 patients and speech function tests which comprised of Kim's method, Bzoch's method and Allison's method were done in 4 patients.
RESULTS
Six patients were found to be stage T4 primary tumors and one was stage a T3 primary tumor. The lateral thigh free flap was most commonly was used in five cases. In two cases, either a rectus abdominis free flap or a radial forearm free flap was used. Six patients received postoperative radiotherapy. Currently, four patients are completely cured but three developed recurrence, of whom two have expired and one is living. Six patients regained swallowing and independent oral alimentation. MBS showed poor intraoral transport but, good propulsive pharyngeal emptying. Also, they regained intelligible speech. Speech intelligibility was grade 4 in all patients.
CONCLUSION
The reconstruction with the free flap after total glossectomy provides considerably satisfactory functional results in swallowing and speech as well as providing better oncologic results in advanced tongue cancers.