Analysis of the relations between the shape of the reconstructed tongue and postoperative functions after subtotal or total glossectomy.
OBJECTIVE
For reconstruction after subtotal or total glossectomy, both preserving the larynx and maintaining postoperative swallowing and speech functions can greatly improve quality of life; however, postoperative functional results are often unstable. Our experiences suggest that insufficient flap volume in the oral area and postoperative prolapse of the preserved larynx affect postoperative function. The objective was to investigate the relations of the shape of the reconstructed tongue to postoperative swallowing and speech functions.


METHODS
The shape of the reconstructed tongue was classified on the basis of magnetic resonance and intraoral inspection as protuberant, semi-protuberant, flat, or depressed. Speech intelligibility was evaluated, and body weight, which might affect the shape of the transferred flap, was measured before and after surgery.


METHODS
Thirty patients who had undergone subtotal or total glossectomy and subsequent reconstruction were reviewed.


RESULTS
We found that speech intelligibility (P <.001), food (P <.01), and deglutition (P <.003) scores were significantly lower in patients with flat or depressed tongues than in patients with semi-protuberant or protuberant tongues. Weight loss after surgery was significantly greater in patients with depressed tongues than in other patients (P <.013). Our results indicate that postoperative function is related to the shape of the reconstructed tongue.


CONCLUSIONS
We suggest that 1) wider and thicker flaps, such as rectus abdominis musculocutaneous flaps, be used; 2) flaps be designed to be approximately 30% wider than the defect; 3) laryngeal suspension be used to prevent prolapse of the transferred flap; and 4) careful general management and sufficient nutrition are important in the early postoperative period.
Kimata
Yoshihiro
Y
Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. ykimata@east.ncc.go.jp
Sakuraba
Minoru
M
Hishinuma
Shigeyuki
S
Ebihara
Satoshi
S
Hayashi
Ryuichi
R
Asakage
Takahiro
T
Nakatsuka
Takashi
T
Harii
Kiyonori
K
D000328:Adult; D000368:Aged; D000886:Anthropometry; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005927:Glossectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D011183:Postoperative Complications; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D013064:Speech Disorders / Q000175:diagnosis / Q000209:etiology; D013065:Speech Intelligibility; D013524:Surgical Flaps; D014059:Tongue / Q000601:surgery*