title: Swallowing after free-flap reconstruction in patients with oral and pharyngeal cancer.
abstract: Swallowing and intraoral sensation outcome were investigated prospectively after microvascular free-flap reconstruction. Forty-one patients with a large oral or oropharyngeal carcinoma underwent free-flap surgery usually combined with radiotherapy. The patients completed modified barium swallow, self-rating of swallowing, and 2-point moving discrimination preoperatively and at four time points during the 12-month follow-up period, and a plain chest X-ray one year after operation. Swallowing was impaired with respect to an objective and subjective measure after therapy. Rates for nonsilent and silent aspiration increased during the follow-up. Intraoral sensation deteriorated. Swallowing outcome was not related to sensation. One year after surgery, 86% of the patients ate regular masticated or soft food. Microvascular transfers offer a reasonable option for oral reconstruction. This study does not support the need for sensate flaps. Swallowing problems should be routinely sought and patients rehabilitated during a sufficiently long follow-up with videofluorography regardless of the patient's perception of swallowing.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland. mari.markkanen-leppanen@hus.fi
authors.forename: Mari
authors.initials: M
authors.lastname: Markkanen-Leppänen
authors.forename: Elina
authors.initials: E
authors.lastname: Isotalo
authors.forename: Antti A
authors.initials: AA
authors.lastname: Mäkitie
authors.forename: Eija
authors.initials: E
authors.lastname: Rorarius
authors.forename: Sirpa
authors.initials: S
authors.lastname: Asko-Seljavaara
authors.forename: Timo
authors.initials: T
authors.lastname: Pessi
authors.forename: Erkki
authors.initials: E
authors.lastname: Suominen
authors.forename: Marja-Leena
authors.initials: ML
authors.lastname: Haapanen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009055:Mouth / Q000294:innervation; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010610:Pharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D053120:Respiratory Aspiration / Q000209:etiology / Q000503:physiopathology; D012677:Sensation; D013524:Surgical Flaps / Q000098:blood supply; D014741:Video Recording