Functional outcomes after primary oropharyngeal cancer resection and reconstruction with the radial forearm free flap.
OBJECTIVE
To report prospectively collected aeromechanical, acoustical, and perceptual speech outcomes, as well as preliminary swallowing data, in patients having reconstruction with radial forearm free flaps after primary resection for oropharyngeal cancer.


METHODS
Prospective cohort study.


METHODS
Acoustical, aeromechanical, and perceptual speech data and swallowing data were gathered at three evaluation times (preoperatively and before and after radiation therapy) for patients treated for oropharyngeal cancer by means of primary resection and reconstruction with a radial forearm free flap. Degree of involvement of the soft palate and base of tongue, along with reconstructive techniques, were entered as between-group factors in the analysis.


RESULTS
There were no significant differences in speech intelligibility between the patient groups based on the degree of palate and tongue resected. However, patients with resections of half or more than half of the soft palate had significantly higher nasalance values and larger velopharyngeal orifice areas than individuals who had less than half of the soft palate resected. Significant within-subject differences were revealed across evaluation times for the dependent variables nasalance, velopharyngeal orifice area, and word intelligibility. Ninety-four percent of the patients were able to resume a normal or soft diet. There was a 6% incidence of aspiration in 128 swallows that were analyzed. The amount of base of tongue resected did not significantly affect any of the speech or swallowing parameters.


CONCLUSIONS
Radial forearm free flaps are a good reconstructive option after oropharyngeal cancer extirpation. Our acoustic and aeromechanical results indicated that issues related to quality of the speech signal require further study for resections of half or more than half of the soft palate.
Seikaly
Hadi
H
Divison of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Alberta, Edmonton, Canada. hseikaly@shaw.ca
Rieger
Jana
J
Wolfaardt
John
J
Moysa
Gerald
G
Harris
Jeffery
J
Jha
Naresh
N
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005542:Forearm / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009959:Oropharyngeal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010160:Palate, Soft / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D011884:Radius / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012720:Severity of Illness Index; D013061:Speech Acoustics; D013064:Speech Disorders / Q000175:diagnosis / Q000209:etiology; D013524:Surgical Flaps; D014062:Tongue Neoplasms / Q000473:pathology / Q000601:surgery*