Swallowing after free-flap reconstruction in patients with oral and pharyngeal cancer.
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.
Markkanen-Leppänen
Mari
M
Department of Otolaryngology-Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland. mari.markkanen-leppanen@hus.fi
Isotalo
Elina
E
Mäkitie
Antti A
AA
Rorarius
Eija
E
Asko-Seljavaara
Sirpa
S
Pessi
Timo
T
Suominen
Erkki
E
Haapanen
Marja-Leena
ML
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