Long-term Functional Outcomes of Total Glossectomy With or Without Total Laryngectomy.
OBJECTIVE
The optimal reconstruction of total glossectomy defects with or without total laryngectomy is controversial. Various pedicled and free tissue flaps have been advocated, but long-term data on functional outcomes are not available to date.


OBJECTIVE
To compare various total glossectomy defect reconstructive techniques used by multiple institutions and to identify factors that may lead to improved long-term speech and swallowing function.


METHODS
A multi-institutional, retrospective review of electronic medical records of patients undergoing total glossectomy at 8 participating institutions between June 1, 2001, and June 30, 2011, who had a minimal survival of 2 years.


METHODS
Total glossectomy with or without total laryngectomy.


METHODS
Demographic and surgical factors were compiled and correlated with speech and swallowing outcomes.


RESULTS
At the time of the last follow-up, 45% (25 of 55) of patients did not have a gastrostomy tube, and 76% (42 of 55) retained the ability to verbally communicate. Overall, 75% (41 of 55) of patients were tolerating at least minimal nutritional oral intake. Feeding tube dependence was not associated with laryngeal preservation or the reconstructive techniques used, including flap suspension, flap innervation, or type of flap used. Laryngeal preservation was associated with favorable speech outcomes, such as the retained ability to verbally communicate in 97% of those not undergoing total laryngectomy (35 of 36 patients) vs 44% (7 of 16) in those undergoing total laryngectomy (P < .001), as well as those not undergoing total laryngectomy achieving some or all intelligible speech in 85% (29 of 34 patients) compared with 31% (4 of 13) undergoing total laryngectomy achieving the same intelligibility (P < .001).


CONCLUSIONS
In patients with total glossectomy, feeding tube dependence was not associated with laryngeal preservation or the reconstructive technique, including flap innervation and type of flap used. Laryngeal preservation was associated with favorable speech outcomes such as the retained ability to verbally communicate and higher levels of speech intelligibility.
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.
Derrick T
DT
Lin
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.
Bharat B
BB
Yarlagadda
Harvard Medical School, Boston, Massachusetts.
Rosh K V
RK
Sethi
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland.
Allen L
AL
Feng
Department of Otolaryngology-Head and Neck Surgery, Kansas University Medical Center, Kansas City.
Yelizaveta
Y
Shnayder
Department of Otolaryngology-Head and Neck Surgery, Kansas University Medical Center, Kansas City.
Levi G
LG
Ledgerwood
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri.
Jason A
JA
Diaz
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri.
Parul
P
Sinha
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston.
Matthew M
MM
Hanasono
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston.
Peirong
P
Yu
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston.
Roman J
RJ
Skoracki
Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans.
Timothy S
TS
Lian
Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois.
Urjeet A
UA
Patel
Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida.
Jason
J
Leibowitz
Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida.
Nicholas
N
Purdy
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland.
Heather
H
Starmer
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland.
Jeremy D
JD
Richmon
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000209:etiology*; D057286:Electronic Health Records; D005260:Female; D005774:Gastrostomy; D005927:Glossectomy; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D013064:Speech Disorders / Q000209:etiology*; D013065:Speech Intelligibility; D013524:Surgical Flaps / Q000601:surgery; D014062:Tongue Neoplasms / Q000601:surgery*