51
|
Abstract
The number of oral cavity and oropharyngeal cancer survivors is rising. By 2030, oropharyngeal cancers are projected to account for almost half of all head and neck cancers. Normal speech, swallowing, and respiration can be disrupted by adverse effects of tumor and cancer therapy. This review summarizes clinically distinct functional outcomes of patients with oral cavity and oropharyngeal cancers, methods of pretreatment functional assessments, strategies to reduce or prevent functional complications, and posttreatment rehabilitation considerations.
Collapse
Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology & Audiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA.
| | | |
Collapse
|
52
|
Rihani J, Lee MR, Lee T, Ducic Y. Flap selection and functional outcomes in total glossectomy with laryngeal preservation. Otolaryngol Head Neck Surg 2013; 149:547-53. [PMID: 23884285 DOI: 10.1177/0194599813498063] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Reconstruction of total glossectomy defects has been revolutionized by the popularity of free flap use in the head and neck. Challenging defects can be addressed with a variety of different free and pedicled flaps. The purpose of this study is to review our method of flap selection in cases of total glossectomy defects with laryngeal preservation, with an emphasis on the variations of these defects and patient body habitus. STUDY DESIGN Case series with chart review. SETTING Tertiary care referral center. SUBJECTS AND METHODS All patients undergoing total glossectomy with laryngeal preservation (TGLP) by the senior author (YD) from September 1997 to May 2012. Objective data regarding patient demographics, existing defect, method of reconstruction, adjuvant treatment, operative details, outcomes, and complications were recorded. Both means and frequency of prolonged tracheostomy or gastrostomy tube were used to assess outcomes. RESULTS One hundred and three patients were identified. Ninety-four met inclusion criteria. All patients were T3 or T4 stage tumors. Mean follow-up was 3.4 years. Fifty-nine patients (62%) underwent free flap reconstruction while the remaining 35 (37%) were treated with a pedicled pectoralis myocutaneous flap. Tracheostomy decannulation and gastrostomy tube removal rates were 84% and 29%, respectively. No patients were converted to total laryngectomy. CONCLUSION Optimal reconstruction of TGLP defects may be accomplished with either pedicled or free-tissue flap reconstruction. Selecting an ideal flap for reconstruction of total glossectomy defects should be patient specific and based on matching donor flap bulk. This treatment approach demonstrates high tracheostomy and gastric tube independence.
Collapse
Affiliation(s)
- Jordan Rihani
- Departments of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | |
Collapse
|
53
|
Joo YH, Hwang SH, Park JO, Cho KJ, Kim MS. Functional outcome after partial glossectomy with reconstruction using radial forearm free flap. Auris Nasus Larynx 2013; 40:303-7. [DOI: 10.1016/j.anl.2012.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 07/11/2012] [Accepted: 07/14/2012] [Indexed: 11/29/2022]
|
54
|
Speech and swallowing following tongue cancer surgery and free flap reconstruction – A systematic review. Oral Oncol 2013; 49:507-24. [DOI: 10.1016/j.oraloncology.2013.03.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 02/04/2013] [Accepted: 03/04/2013] [Indexed: 11/20/2022]
|
55
|
Rihani J, Lee T, Ducic Y. Secondary Onlay Free Flap Reconstruction of Glossectomy Defects following Initial Successful Flap Restoration. Otolaryngol Head Neck Surg 2013; 149:232-4. [DOI: 10.1177/0194599813486882] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients who undergo tongue reconstruction over time may develop gradual worsening of dysarthria and dysphagia secondary to flap atrophy. At our institution, these patients undergo a secondary flap onlay procedure for augmentation of the neotongue. We review a total of 11 patients with total glossectomy defect who underwent secondary tongue augmentation with secondary onlay free flap consisting of radial forearm free flap (n = 6) and rectus free flap (n = 5). There was improvement in swallowing in 7 of 11 patients. Five (45.4%) patients achieved gastric tube independence. Seven (63.6%) patients achieved a varying degree of oral intake. All patients achieved tracheostomy independence. Dysarthria was improved in all patients. There were no flap failures. Therefore, a secondary onlay flap technique is feasible and may improve dysphagia and dysarthria to achieve gastric tube and tracheostomy independence in total glossectomy patients with delayed tongue atrophy.
Collapse
Affiliation(s)
- Jordan Rihani
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas Lee
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA
| | - Yadranko Ducic
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA
| |
Collapse
|
56
|
Navach V, Zurlo V, Calabrese L, Massaro MA, Bruschini R, Giugliano G, Ansarin M, Chiesa F. Total glossectomy with preservation of the larynx: oncological and functional results. Br J Oral Maxillofac Surg 2013; 51:217-23. [DOI: 10.1016/j.bjoms.2012.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 07/16/2012] [Indexed: 10/28/2022]
|
57
|
|
58
|
Tei K, Sakakibara N, Yamazaki Y, Ohiro Y, Ono M, Totsuka Y. Does Swallowing Function Recover in the Long Term in Patients With Surgically Treated Tongue Carcinomas? J Oral Maxillofac Surg 2012; 70:2680-6. [DOI: 10.1016/j.joms.2012.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 01/16/2012] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
|
59
|
Dziegielewski PT, Ho ML, Rieger J, Singh P, Langille M, Harris JR, Seikaly H. Total glossectomy with laryngeal preservation and free flap reconstruction: objective functional outcomes and systematic review of the literature. Laryngoscope 2012; 123:140-5. [PMID: 22952109 DOI: 10.1002/lary.23505] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2012] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Advanced tongue cancer is a devastating diagnosis with potential for significant morbidity after treatment. This is especially true for patients undergoing total glossectomy with laryngeal preservation (TGLP), free flap reconstruction and adjuvant radiotherapy. The goals of this study were to: 1) determine long-term objective functional and quality of life outcomes, 2) investigate the influence of rehabilitation on functional recovery and 3) determine swallowing ability in patients with TGLP. STUDY DESIGN Prospective cohort study and systematic review of the literature. METHODS Functional outcomes data were collected from 2000-2010. Outcomes were measured pre- and 12 months post-surgery and included: gastrostomy-tube (G-Tube) rates, swallowing transit times on video fluoroscopic swallowing studies, speech intelligibility and EORTC-H&N 35 quality of life scores. A systematic review of the literature was conducted to determine comprehensive long term G-Tube rates. RESULTS Twelve patients were included and eight were still living at 12 months post-surgery. Fifty percent of patients in this study and 24% with systematic review used G-Tubes at 1 year post-surgery. Patients who could swallow did not aspirate, but more than doubled swallowing transit times. Spoken sentence intelligibility averaged 66% and mean quality of life scores improved 8.9 points 12 months post-surgery. Patients who attended >80% of swallowing and speech rehabilitation sessions demonstrated superior swallowing and speech functional outcomes. CONCLUSIONS Although a potentially morbid treatment, TGLP and free flap reconstruction can provide good swallowing and speech outcomes as well as meaningful long-term quality of life. Regular attendance of rehabilitation sessions is imperative to optimize functional outcomes.
Collapse
Affiliation(s)
- Peter T Dziegielewski
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada
| | | | | | | | | | | | | |
Collapse
|
60
|
Omori M, Sakakibara S, Hashikawa K, Terashi H, Tahara S, Sugiyama D. Comparison of reinnervation for preservation of denervated muscle volume with motor and sensory nerve: An experimental study. J Plast Reconstr Aesthet Surg 2012; 65:943-9. [DOI: 10.1016/j.bjps.2012.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 12/26/2011] [Accepted: 01/26/2012] [Indexed: 11/26/2022]
|
61
|
Miyamoto S, Sakuraba M, Nagamatsu S, Kayano S, Kamizono K, Hayashi R. Risk Factors for Gastric-Tube Dependence Following Tongue Reconstruction. Ann Surg Oncol 2012; 19:2320-6. [DOI: 10.1245/s10434-012-2298-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Indexed: 11/18/2022]
|
62
|
Kaipa R, Robb MP, O'Beirne GA, Allison RS. Recovery of speech following total glossectomy: an acoustic and perceptual appraisal. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2012; 14:24-34. [PMID: 22257069 DOI: 10.3109/17549507.2011.623326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study involved an acoustic and perceptual analysis of the speech produced by a 31-year-old female following total glossectomy. Speech samples were collected on three occasions within the first 3 months following glossectomy. Vowel articulation was examined acoustically as a function of vowel space and the Euclidean distance separating corner vowels. Perceptual analyses involved presentation of the participant's CV productions to 30 healthy adult listeners who made forced-choice identifications of consonant type. Acoustic analysis revealed improvements in vowel space area and an increase in the Euclidean distances. The perceptual results revealed a statistically significant deterioration in consonants over the 3-month period with anterior sounds being perceived more correctly than medial and posterior sounds. The current study highlights the variable nature of speech following glossectomy, with greater improvements in vowel articulation compared to consonant articulation during the earliest stages of surgical recovery.
Collapse
Affiliation(s)
- Ramesh Kaipa
- Department of Communication Disorders,University of Canterbury, Christchurch, New Zealand.
| | | | | | | |
Collapse
|
63
|
Higgins KM, Erovic BM, Ravi A, Yeung R, Lee JW, Yao C, Enepekides DJ. Volumetric changes of the anterolateral thigh free flap following adjuvant radiotherapy in total parotidectomy reconstruction. Laryngoscope 2012; 122:767-72. [DOI: 10.1002/lary.22509] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 10/13/2011] [Accepted: 11/28/2011] [Indexed: 11/09/2022]
|
64
|
Shin YS, Koh YW, Kim SH, Jeong JH, Ahn S, Hong HJ, Choi EC. Radiotherapy Deteriorates Postoperative Functional Outcome After Partial Glossectomy With Free Flap Reconstruction. J Oral Maxillofac Surg 2012; 70:216-20. [DOI: 10.1016/j.joms.2011.04.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 04/11/2011] [Indexed: 10/17/2022]
|
65
|
Yamaguchi K, Kimata Y, Onoda S, Mizukawa N, Onoda T. Quantitative analysis of free flap volume changes in head and neck reconstruction. Head Neck 2011; 34:1403-7. [DOI: 10.1002/hed.21944] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2011] [Indexed: 11/06/2022] Open
|
66
|
Vega C, León X, Cervelli D, Pons G, López S, Fernández M, Quer M, Masià J. Total or subtotal glossectomy with microsurgical reconstruction: Functional and oncological results. Microsurgery 2011; 31:517-23. [DOI: 10.1002/micr.20922] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 04/22/2011] [Indexed: 11/07/2022]
|
67
|
Kanazawa T, Sarukawa S, Fukushima H, Takeoda S, Kusaka G, Ichimura K. Current reconstructive techniques following head and neck cancer resection using microvascular surgery. Ann Vasc Dis 2011; 4:189-95. [PMID: 23555452 DOI: 10.3400/avd.ra.11.00009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 04/24/2011] [Indexed: 11/13/2022] Open
Abstract
Various techniques have been developed to reconstruct head and neck defects following surgery to restore function and cosmetics. Free tissue transfer using microvascular anastomosis has transformed surgical outcomes and the quality of life for head and neck cancer patients because this technique has made it possible for surgeons to perform more aggressive ablative surgery, but there is room for improvement to achieve a satisfactory survival rate. Reconstruction using the free tissue transfer technique is closely related to cardiovascular surgery because the anastomosis techniques used by head and neck surgeons are based on those of cardiovascular surgeons; thus, suggestions from cardiovascular surgeons might lead to further development of this field. The aim of this article is to present the recent general concepts of reconstruction procedures and our experiences of reconstructive surgeries of the oral cavity, mandible, maxilla, oropharynx and hypopharynx to help cardiovascular surgeons understand the reconstructions and share knowledge among themselves and with neck surgeons to develop future directions in head and neck reconstruction.
Collapse
Affiliation(s)
- Takeharu Kanazawa
- Department of Otolaryngology / Head and Neck Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | | | | | | | | | | |
Collapse
|
68
|
Sinclair CF, Carroll WR, Desmond RA, Rosenthal EL. Functional and Survival Outcomes in Patients Undergoing Total Glossectomy Compared with Total Laryngoglossectomy. Otolaryngol Head Neck Surg 2011; 145:755-8. [DOI: 10.1177/0194599811412724] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To compare functional and survival outcomes for patients undergoing total glossectomy (TG) or total glossectomy plus laryngectomy (TGL) for advanced squamous cell carcinoma (SCC) of the tongue. Study Design. Case series with chart review. Setting. Academic tertiary referral center. Subjects and Methods. There were 30 included patients (20 TG, 10 TGL). Outcomes included tumor recurrence, disease-free survival, and functional data (swallowing, gastrostomy tube dependence, speech, airway). Results. Mean patient age was 56 years with a male predominance (90%). Compared with TG, TGL was more commonly performed for recurrent tumors (90% vs 55%, P = .06). Perineural invasion and extracapsular extension occurred more commonly in the TGL group (80% vs 50%, P = .12). At 12 months postoperatively, 61% of TG patients had disease recurrence compared with 40% of TGL patients ( P = .43), and 12-month disease-free survival was 40% (TG) and 50% (TGL). Functionally, more TG patients were totally gastrostomy tube dependent (70% vs 30%, P = .04), and 50% of TG patients were also tracheostomy dependent. Intelligible speech was achieved by 30% of TG and 10% of TGL patients ( P = .68). Conclusion. Patients undergoing TGL had similar functional and survival outcomes to patients undergoing TG alone despite the presence of more locally advanced disease with greater adverse pathological features. Following TG alone, positive or close margins occurred most commonly at the inferior margin of resection (hyoid/valleculae), which could explain why TGL in patients with advanced tongue SCC may improve local disease control.
Collapse
Affiliation(s)
- Catherine F. Sinclair
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William R. Carroll
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Renee A. Desmond
- Department of Medicine, Medical Statistics Section, Biostatistics and Bioinformatics Unit, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eben L. Rosenthal
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
69
|
Kokemueller H, Rana M, Rublack J, Eckardt A, Tavassol F, Schumann P, Lindhorst D, Ruecker M, Gellrich NC. The Hannover experience: surgical treatment of tongue cancer--a clinical retrospective evaluation over a 30 years period. HEAD & NECK ONCOLOGY 2011; 3:27. [PMID: 21600000 PMCID: PMC3123311 DOI: 10.1186/1758-3284-3-27] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 05/21/2011] [Indexed: 12/03/2022]
Abstract
Objectives In this retrospective study, we present a clinical review of our experience with tongue cancer in order to obtain valid criteria for therapeutic decision-making. Materials and methods Between 1980 and 2009, a total of 341 patients with squamous cell carcinoma of the tongue were treated at our Department. The average follow-up was 5.2 years. 309 patients received surgical treatment, which was combined in nearly 10% with neoadjuvant and in nearly 20% with postoperative radio(chemo)therapy. 32 patients were excluded from surgery and received primary radiation. Results Local and regional failure occurred in 23.9% and 20.4%, leading to a total failure rate of 37.2% after an average duration of 1,6 years. N-Status, extracapsular spread and clear margins were identified as the dominant factors for survival, which was calculated with 54.5% after 5 years. Conclusions We recommend categorical bilateral neck dissection in order to reliably remove occult lymph node metastases. Adjuvant treatment modalities should be applied more frequently in controlled clinical trials and should generally be implemented in cases with unclear margins and lymphatic spread. Clinical relevance This study provides new treatment strategies for primary tumour disease and for tumour recurrence.
Collapse
Affiliation(s)
- Horst Kokemueller
- Department for Oral and Maxillofacial Surgery, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Majeed Rana
- Department for Oral and Maxillofacial Surgery, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jennifer Rublack
- Department for Oral and Maxillofacial Surgery, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Andre Eckardt
- Department for Oral and Maxillofacial Surgery, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Frank Tavassol
- Department for Oral and Maxillofacial Surgery, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Paul Schumann
- Department for Oral and Maxillofacial Surgery, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Daniel Lindhorst
- Department for Oral and Maxillofacial Surgery, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Martin Ruecker
- Department for Oral and Maxillofacial Surgery, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Nils-Claudius Gellrich
- Department for Oral and Maxillofacial Surgery, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| |
Collapse
|
70
|
Current management of advanced resectable oral cavity squamous cell carcinoma. Clin Exp Otorhinolaryngol 2011; 4:1-10. [PMID: 21461056 PMCID: PMC3062220 DOI: 10.3342/ceo.2011.4.1.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 12/06/2010] [Indexed: 01/03/2023] Open
Abstract
The oral cavity is the most common site of head and neck squamous cell carcinoma, a disease which results in significant morbidity and mortality worldwide. Though the primary modality of treatment for patients with oral cavity cancer remains surgical resection, many patients present with advanced disease and are thus treated using a multi-disciplinary approach. Patients with extracapsular spread of lymphatic metastasis and surgical margins that remain positive have been found to be at high risk for local-regional recurrence and death from disease, and are most often recommended to receive both post-operative radiation as well as systemic chemotherapy. The basis for this approach, as well as scientific developments that underly future trials of novels treatments for patients with high-risk oral cavity cancer are reviewed.
Collapse
|
71
|
Assessment of volume changes of radial forearm free flaps in head and neck cancer: Long-term results. Oral Oncol 2011; 47:72-5. [DOI: 10.1016/j.oraloncology.2010.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 11/01/2010] [Accepted: 11/01/2010] [Indexed: 11/20/2022]
|
72
|
Cho KJ, Joo YH, Sun DI, Kim MS. Perioperative clinical factors affecting volume changes of reconstructed flaps in head and neck cancer patients: free versus regional flaps. Eur Arch Otorhinolaryngol 2010; 268:1061-5. [DOI: 10.1007/s00405-010-1450-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 11/23/2010] [Indexed: 11/30/2022]
|