Adaptive mechanisms of speech and swallowing after combined jaw and tongue reconstruction in long-term survivors.
Twelve patients have been studied for speech and swallowing function after major combined jaw and tongue reconstruction with the microvascular iliac bone and groin skin composite flap. Cinegraphic barium swallows demonstrated that for bolus propulsion, it is important to be able to occlude the palate with the flap. Glottic competence prevents aspiration. Speech studies show that although there is loss of certain speech sounds, approximate sounds are substituted. Speech is intelligible when soft-tissue contact to the palate can be accomplished. The adaptive mechanisms in these patients have been compared with the mechanisms used by a patient with uncorrected congenital aglossia and hypomandibulosis who developed excellent speech and swallowing. The mobility of this patient's mouth and pharynx was similar to that in the reconstructed cancer patients who were able to swallow and speak. This procedure has become our reconstruction method of choice for these major defects.
Allison
G R
GR
Department of Surgery, University of California, Irvine, Orange 92668.
Rappaport
I
I
Salibian
A H
AH
McMicken
B
B
Shoup
J E
JE
Etchepare
T L
TL
Krugman
M E
ME
D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D002933:Cineradiography; D003679:Deglutition; D006119:Groin; D006801:Humans; D008334:Mandible / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery; D008875:Middle Aged; D016038:Skin Transplantation; D013065:Speech Intelligibility; D013524:Surgical Flaps; D014059:Tongue / Q000601:surgery*; D014062:Tongue Neoplasms / Q000601:surgery