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Li Y, Ruan S, Hong Y, Zhuang F, Zheng C, Lu M, Chen X. Reconstruction of laryngeal function by thyroid cartilage fenestration and draw-out resection followed by internal fixation with titanium microplates for early glottic carcinoma: a novel and efficient surgical approach. Am J Transl Res 2024; 16:2589-2598. [PMID: 39006276 PMCID: PMC11236634 DOI: 10.62347/atpe6857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/25/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To explore the clinical effectiveness of reconstructing laryngeal function using thyroid cartilage fenestration and "draw-out" resection, supplemented by internal fixation with titanium microplates in early glottic carcinoma. METHODS Data from 99 patients with glottic carcinoma treated in the Second Affiliated Hospital of Fujian Medical University between January 2014 and September 2021 were retrospectively analyzed. Forty-eight patients who underwent thyroid cartilage fenestration and resection followed by internal fixation with titanium microplates for laryngeal function reconstruction were assigned to the thyroid cartilage fenestration group (TCF group), while the other 51 patients who underwent sternohyoid muscle and fascia repair for laryngeal function reconstruction were assigned to the sternohyoid muscle repair group (SMR group). Patients were followed up for 1-8 years. Data on postoperative phonatory function, respiratory function, swallowing function, and survival status were collected. RESULTS Compared to the SMR group, patients in the TCF group showed better postoperative recovery in phonatory function and verbal communication (all P<0.05). In the TCF group, patients demonstrated stable respiration and the extubation rate was 100.00%, which was significantly higher than 82.35% in the SMR group (P<0.05). Patients in both groups showed good postoperative recovery of swallowing function (P>0.05). CONCLUSION One-stage reconstruction of laryngeal function by thyroid cartilage fenestration and "draw-out" resection with adjuvant internal titanium microplate fixation in early glottic carcinoma demonstrates good postoperative recovery and good preservation of the laryngeal function.
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Affiliation(s)
- Yahong Li
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
| | - Shenjiong Ruan
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
| | - Yuming Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
| | - Feiyi Zhuang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
| | - Chaohui Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
| | - Ming Lu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
| | - Xiaofang Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
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Morita T, Sasaki T, Koizumi Y, Fukushima H, Shimbashi W, Mitani H. Favourable swallowing outcomes after subtotal glossectomy with laryngeal suspension. Int J Oral Maxillofac Surg 2024; 53:191-198. [PMID: 37516548 DOI: 10.1016/j.ijom.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
Subtotal or total glossectomy for advanced tongue cancer has an adverse impact on swallowing. The purpose of this retrospective study was to analyse postoperative swallowing outcomes and to determine the ideal reconstruction method in these patients. The clinical and swallowing data of patients with tongue cancer who underwent subtotal glossectomy at the study institution between 2005 and 2019 were reviewed retrospectively. Data were available for 101 patients. The most common reconstruction method was a free rectus abdominis musculocutaneous flap (69 cases). The postoperative feeding tube dependency rate was 11.1% at discharge and 9.4% at 1 year. During the study period, laryngeal suspension and/or a cricopharyngeal myotomy was performed in 39 patients (38.6%), with 25 of these operations performed after 2017. Patients treated in 2017-2019 were significantly more able to take thin liquid (P < 0.001) and lost less weight (P = 0.015) compared to those treated in 2005-2016. Multivariate analysis of 61 patients who did not undergo laryngeal suspension and/or cricopharyngeal myotomy showed significant feeding tube dependency in those aged 65 years and older (P = 0.004). Thin liquid intake was significantly improved after subtotal glossectomy with laryngeal suspension, which led to better postoperative swallowing and improved quality of life.
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Affiliation(s)
- T Morita
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - T Sasaki
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Koizumi
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - H Fukushima
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - W Shimbashi
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - H Mitani
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Mitra S, Panda S, Thakar A, Gautam V, Talukdar KM, Mani S, Singh CA, Sikka K, Kumar R, Das SK, Singh A. Quality of life and swallowing outcomes following major glossectomy: A prospective single-center experience. Head Neck 2024; 46:599-608. [PMID: 38146690 DOI: 10.1002/hed.27612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND There exists a lacuna in the structured reporting of swallowing dysfunction and quality of life (QoL) outcome following major glossectomy. METHODS Prospective cohort study to assess the swallowing dysfunction and QoL following STG (subtotal glossectomy) or NTG (near total glossectomy) over a 6-month period using FEES and PAS scale, MDADI, and FACT-HN. RESULTS Twenty-four patients were available for analysis. The pre- and post-adjuvant evaluation revealed a statistically significant improvement in the composite MDADI and FACT-HN scores. Subscale analysis of FACT-HN scores revealed maximum deficit in the head and neck cancer-specific score domain followed by functional domain and social well-being domain, with serial improvement noted in the post-adjuvant setting. CONCLUSION This study showed serial improvement in terms of swallowing dysfunction although social and functional well-being domains related to QoL continued to reveal major deficits. Better outcomes were seen with preservation of bilateral base of tongue and mandible.
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Affiliation(s)
- Sandipta Mitra
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Panda
- Department of ENT-Oncology, National Cancer Institute-AIIMS, Jhajjar, India
| | - Alok Thakar
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vimmi Gautam
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kaustav M Talukdar
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh Mani
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Chirom Amit Singh
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Kumar Das
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anup Singh
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Patil YJ, Yakoub M, Moreno KF, Cotton C, Tabangin ME, Altaye M, Patil RD, Tang A, Zender C, Domack A. The effect of transfusion on survival in head and neck cancer after free tissue reconstruction. Laryngoscope Investig Otolaryngol 2024; 9:e1215. [PMID: 38362201 PMCID: PMC10866597 DOI: 10.1002/lio2.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 02/17/2024] Open
Abstract
Objective To examine if perioperative blood transfusion affects overall survival (OS) and recurrence-free survival (RFS) in head and neck cancer patients who undergo free tissue reconstruction. Design Retrospective cohort study. Methods The medical records of free tissue flaps between 2007 and 2010 were reviewed. Differences in demographics and clinical factors based on the level of transfused packed red blood cells (PRBC) were examined using chi-squared tests, Kruskal-Wallis tests, and/or ANOVA tests. Survival time was compared using a Cox proportional hazard model. Results Data were available for 183 patients. Patients who had PRBC transfusion significantly differed from the non-transfused group by flap type, flap with bone, Charlson Comorbidity Index (CCI), and hemoglobin and hematocrit. When stratified into three groups based on units of PRBC; flap type, flap with bone, CCI, preoperative hemoglobin, and hematocrit were found to differ significantly. The 2-year Kaplan-Meier plot demonstrated improved OS for those who did not receive any PRBC transfusion. The use of more than 3 units of blood decreased 2-year OS significantly when compared to the non-transfused group. Finally, after adjusting for CCI using a Cox proportional hazard model, survival was significantly affected by CCI. Conclusion After controlling for patient age, oncologic stage, cancer subsite, histology, type of free flap, vascularized bone-containing flap, recurrence type, CCI, and preoperative hemoglobin and hematocrit, patients who received 3 or more units of PRBC in the perioperative period had significantly decreased OS. RFS did not differ between the transfused versus non-transfused groups. Level of Evidence Level 4.
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Affiliation(s)
- Yash J. Patil
- Department of Otolaryngology Head and Neck SurgeryUniversity of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Mohamed Yakoub
- Department of Pathology and Laboratory MedicineUniversity of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Kattia F. Moreno
- Department of Otolaryngology Head and Neck SurgeryUniversity of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Colin Cotton
- University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Meredith E. Tabangin
- Division of Biostatistics and EpidemiologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Mekibib Altaye
- Division of Biostatistics and EpidemiologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Reena Dhanda Patil
- Department of Otolaryngology Head and Neck SurgeryUniversity of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Alice Tang
- Department of Otolaryngology Head and Neck SurgeryUniversity of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Chad Zender
- Department of Otolaryngology Head and Neck SurgeryUniversity of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Aaron Domack
- Head and Neck DepartmentAdventHealthOrlandoFloridaUSA
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Hanubal KS, Reschly WJ, Conrad D, Festa BM, Weiss JP, Shama M, Danan D, Hughley B, Dziegielewski PT. The beavertail modified radial forearm free flap: Retrospective review of a versatile technique to increase flap bulk in the head and neck. Microsurgery 2023; 43:767-774. [PMID: 36892139 DOI: 10.1002/micr.31028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/07/2023] [Accepted: 02/10/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE Utilization of free tissue transfers in head and neck reconstruction has greatly increased due to their dependability and reliability. Anterolateral thigh (ALT) and rectus abdominus (RA) free flaps may provide too much soft tissue bulk, especially in patients with a large body habitus. A radial forearm free flap (RFFF) may be modified with a "beaver tail" (BT), which provides a flap whose bulk may be tailored to a defect. The purpose of this paper is to describe the technique, how it can be used for a variety of defects and the outcomes of these reconstructions. METHODS A retrospective review of prospectively collected data was performed at single tertiary care center between 2012 and 2022. BT-RFFF was designed by leaving a fibroadipose tail vascularized to branches of the radial artery or separated from the vascular pedicle and left attached to the proximal portion of the skin paddle. Functional outcomes, tracheostomy dependence, and gastrostomy tube (G-tube) dependence as well as complications were determined. RESULTS Fifty-eight consecutive patients undergoing BTRFFF were included. Defects reconstructed included: oral tongue and/or floor of mouth 32 (55%), oropharynx 10 (17%), parotid 6 (10%), orbit 6 (10%), lateral temporal bone 3 (5%), and mentum 1 (2%). Indications for BTRFF were: need for bulk when the ALT and RA were too thick (53%) and need for a separate subcutaneous flap for contouring or deep defect lining (47%). Complications directly related to beavertail included a widened forearm scar (100%), wrist contracture (2%) partial flap loss (2%), and flap loss requiring a revision flap (3%). Ninety-three percent of patients with oral/oropharyngeal defects and 12-month follow-up tolerated oral intake without aspiration and 76% were tube-independent. Ninety-three percent were tracheostomy-free at last follow-up. CONCLUSION The BTRFF is a useful tool for reconstructing complex 3D defects requiring bulk where an ALT or rectus would otherwise provide too much bulk.
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Affiliation(s)
- Krishna S Hanubal
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - William J Reschly
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Dustin Conrad
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Bianca Maria Festa
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Joshua P Weiss
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Mohamed Shama
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Deepa Danan
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Brian Hughley
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
- Health Cancer Center, University of Florida, Gainesville, Florida, USA
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Pyne JM, Davis CM, Kelm R, Bussolaro C, Dobrovolsky W, Seikaly H. Advanced mandibular reconstruction with fibular free flap and alloplastic TMJ prosthesis with digital planning. J Otolaryngol Head Neck Surg 2023; 52:44. [PMID: 37400904 DOI: 10.1186/s40463-023-00639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 04/04/2023] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION Resection of the mandible and temporomandibular joint (TMJ) without formal reconstruction is a devastating condition that negatively affects all aspects of the patient's life. We have approached the reconstruction of mandibular defects that include the condyle with simultaneous reconstruction with a vascularized free fibular flap (FFF) using Surgical Design and Simulation (SDS) and alloplastic TMJ prosthesis. The objective of this study is to report the functional and quality of life (QOL) outcomes in a cohort of patients that had undergone our reconstructive protocol. METHODS This was a prospective case series of adult patients that underwent mandibular reconstruction with FFF and alloplastic TMJ prosthesis at the our center. Pre-operative and post-operative maximum inter-incisal opening (MIO) measurements were collected, and patients completed a QOL questionnaire (EORTC QLQ-H&N35) during those perioperative visits. RESULTS Six patients were included in the study. The median patient age was 53 years. Heat map analysis of the QOL questionnaire revealed that patients reported a positive clinically significant change in the domains of pain, teeth, mouth opening, dry mouth, sticky saliva, and senses (relative change of 2.0, 3.3, 3.3, 2.0, 2.0, and 1.0 respectively). There were no negative clinically significant changes. There was a median perioperative MIO increase of 15.0 mm, and this was statistically significant (p = 0.027). CONCLUSIONS This study highlights the complexities involved in mandibular reconstruction with involvement of the TMJ. Based on our findings, patients can obtain an acceptable QOL and good function following simultaneous reconstruction with FFF employing SDS and an alloplastic TMJ prosthesis.
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Affiliation(s)
- Justin M Pyne
- Division of Otolaryngology - Head and Neck Surgery, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Clayton M Davis
- Division of Oral and Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Ryan Kelm
- Division of Oral and Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Claudine Bussolaro
- Division of Oral and Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Walter Dobrovolsky
- Division of Oral and Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Hadi Seikaly
- Division of Otolaryngology - Head and Neck Surgery, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
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Russo E, Alessandri-Bonetti M, Costantino A, Festa BM, Egro FM, Giannitto C, Spriano G, De Virgilio A. Functional outcomes and complications of total glossectomy with laryngeal preservation and flap reconstruction: A systematic review and meta-analysis. Oral Oncol 2023; 141:106415. [PMID: 37149955 DOI: 10.1016/j.oraloncology.2023.106415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To analyze the functional outcomes and complications of total glossectomy with laryngeal preservation and reconstruction with free or pedicled flaps. METHODS A search was conducted using Pubmed/MEDLINE, Cochrane Library, Scopus, and Google Scholar databases. A single arm meta-analysis was performed for feeding tube dependence (FTD), tracheostomy dependence (TD), and speech intelligibility (SI) rates. Peri-operative sequels and complications were evaluated as secondary outcomes. RESULTS A total number of 642 patients (median age: 54.2 years; 95% CI 52.1-58) were included. Functional assessment was performed after a median of 12 months (n = 623/642; 95% CI 10.6-12). Overall, the cumulative FTD rate was 22.9% (n = 188/627; 95% CI 10.2-38.7), the TD rate was 7.3% (n = 95/549; 95% CI 1.9-15.8), and the SI was 91.1% (n = 314/409; 95% CI 80.7%-97.8). The cumulative complication rate was 33.1% (n = 592/642). Eighteen patients (n = 18/592; 3.0%) experienced a major fistula, while aspiration pneumonia occurred in 17 cases (n = 17/592; 2.8%). CONCLUSIONS Total glossectomy with laryngeal preservation and pedicled/free flaps reconstruction may guarantee good functional results and an acceptable quality of life. Further prospective studies are advised to define clinical guidelines about proper patients' and flaps' selection.
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Affiliation(s)
- Elena Russo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Mario Alessandri-Bonetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milan, Italy
| | - Andrea Costantino
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
| | - Bianca Maria Festa
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Francesco Maria Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Caterina Giannitto
- Radiology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
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Choi JW, Alshomer F, Kim YC. Current status and evolution of microsurgical tongue reconstructions, part I. Arch Craniofac Surg 2022; 23:139-151. [PMID: 36068689 PMCID: PMC9449093 DOI: 10.7181/acfs.2022.00654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Reconstructive surgery in the management of head and neck cancer has evolved to include structure-specific approaches in which organ-specific treatment algorithms help optimize outcomes. Tongue cancer management and reconstruction are surgical challenges for which well-executed reconstructive plans should be completed promptly to avoid delaying any subsequently planned oncologic treatment. Crucial considerations in tongue cancer resection are the significant functional morbidity associated with surgical defects, particularly in terms of speech and swallowing, and the consequent negative impact on patients’ quality of life. With the evolution of microsurgical techniques and the development of the perforator flap concept, flap options can be tailored to the characteristics of various tongue defects. This has allowed the implementation of pliable flaps that can help restore tongue mobility and yield subsequent functional outcomes. Using an evolutional framework, we present this series of reviews related to tongue reconstruction. The first part of the review summarizes flap options and flap-related factors, such as volume and tissue characteristics. Related functional aspects are also presented, including tongue mobility, speech, and swallowing, as well as ways to evaluate and optimize these outcomes.
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Affiliation(s)
- Jong-Woo Choi
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Feras Alshomer
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Chul Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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9
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Choi JW, Kim YC, Park HJ, Oh TS, Jeong WS. The impact of dynamic tongue reconstruction using functional muscle transfer: A retrospective review of 94 cases with functional outcome analysis for various glossectomy defects. J Craniomaxillofac Surg 2022; 50:719-731. [DOI: 10.1016/j.jcms.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 07/09/2022] [Accepted: 07/16/2022] [Indexed: 10/16/2022] Open
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10
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Mazerolle P, Fuchsmann C, Schultz P, Benmoussa N, Malard O, Bozec A, Deneuve S, Folia M, Perréard M, Lasne-Cardon A, Chabrillac E, Vergez S, Chaltiel L, Dupret-Bories A. Salvage total glossectomy and total glosso-laryngectomy: Are they worth it? A GETTEC French multicenter study. Oral Oncol 2022; 130:105896. [PMID: 35567979 DOI: 10.1016/j.oraloncology.2022.105896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Salvage total glossectomy (TG) or total glosso-laryngectomy (TGL) remain controversial, as highly morbid procedures. The objective was to describe oncological and functional outcomes after salvage TG or TGL. METHODS We performed a multicenter retrospective study, including patients with previous neck irradiation undergoing TG or TGL for squamous cell carcinoma involving the base of tongue. RESULTS We included 42 patients: 27 in the TG group and 15 in the TGL group. For the entire cohort, median OS and DFS were estimated at 19 months (95% IC [14-44]) and 10 months (95% IC [7-13]) respectively, with no difference between the two groups. After a median follow-up of 90 months, 10 patients (24%) were alive and free of disease. Att he end of follow-up, we noted a gastrostomy dependency of 89% and 87 %respectively in the TG and TGL group, and 48% of patients in the TG group had a tracheotomy. CONCLUSION Although local control is difficult to achieve after salvage TG or TGL, these procedures are associated with acceptable survival and chance of cure for a last-resort situation. TG and TGL can be proposed in selected motivated patients after careful shared decision-making.
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Affiliation(s)
- Paul Mazerolle
- Department of Surgery, University Cancer Institute Toulouse - Oncopole, University Hospital of Toulouse, Toulouse, France
| | - Carine Fuchsmann
- Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Philippe Schultz
- Department of Otorhinolaryngology, Centre Hospitalo-Universitaire de Hautepierre, Strasbourg, France
| | - Nadia Benmoussa
- Department of Head and Neck Surgical Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, 94805, France
| | - Olivier Malard
- Department of Head and Neck Surgery, University Hospital of Nantes, France
| | - Alexandre Bozec
- Department of Head and Neck Surgery, Institut Universitaire de la Face et du Cou, Nice, France
| | - Sophie Deneuve
- Department of Oncologic Surgery, Léon Bérard Center, Lyon, France
| | - Mireille Folia
- Department of Otolaryngology-Head and Neck Surgery, François-Mitterrand University Hospital Center, Dijon, France
| | - Marion Perréard
- Department of Head and Neck Surgery, University Hospital of Caen, France
| | - Audrey Lasne-Cardon
- Department of Head and Neck Surgery, François Baclesse Cancer Center, Caen, France
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute Toulouse - Oncopole, University Hospital of Toulouse, Toulouse, France
| | - Sébastien Vergez
- Department of Surgery, University Cancer Institute Toulouse - Oncopole, University Hospital of Toulouse, Toulouse, France
| | - Léonor Chaltiel
- Biostatistics Unit, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole Toulouse, France
| | - Agnès Dupret-Bories
- Department of Surgery, University Cancer Institute Toulouse - Oncopole, University Hospital of Toulouse, Toulouse, France.
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Burnham AJ, Ottenstein L, Boyce BJ, Kaka AS, El-Deiry MW, Baddour HM, Patel MR, Gross JH, Schmitt NC. Survival, functional, and quality of life outcomes between total glossectomy with and without total laryngectomy: A narrative review. Am J Otolaryngol 2022; 43:103440. [PMID: 35398743 DOI: 10.1016/j.amjoto.2022.103440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND A total glossectomy (TG) may be required for advanced tongue tumors. TG with total laryngectomy (TGL) may be indicated in some cases with tumor extension into the larynx or high risk of aspiration. Total glossectomy with laryngeal preservation (TGLP) may preserve phonation ability relative to TGL, yet TGLP may increase the risk of aspiration. METHODS For this narrative review, we performed a comprehensive literature search of studies relevant to TG and TGL. Clinical studies investigating survival, functional outcomes, and quality of life in following TGLP or TGL were of particular interest. RESULTS Few studies in the literature directly compare survival, functional, and quality of life (QOL) outcomes between TGLP and TGL. TGLP is associated with intelligible speech. However, studies investigating gastrostomy tube dependence following TGLP versus TGL have generated conflicting results. CONCLUSION Further research on functional and QOL outcomes in patients undergoing TGL or TGLP is needed.
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Stephen SE, Murphy JM, Beyer FR, Sellstrom D, Paleri V, Patterson JM. Early postoperative functional outcomes following transoral surgery for oropharyngeal cancer: A systematic review. Head Neck 2021; 44:530-547. [PMID: 34882886 DOI: 10.1002/hed.26938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022] Open
Abstract
There has been increased interest in the use of transoral surgery (TOS) for the treatment of oropharyngeal cancer (OPC). This systematic review summarizes the available evidence for validated functional outcomes following TOS for OPC, within the early postoperative period. Key databases were searched. Primary TOS resections of human subjects were included. Validated functional outcomes extracted included instrumental assessment, clinician rated, and patient reported measures. Database searches yielded 7186 titles between 1990 and December 2020. Full-text articles were obtained for 296 eligible studies, which were screened and a resulting 14 studies, comprising 665 participants were included in the review. Oropharyngeal dysfunction following TOS was observed across all three categories of outcome measures (OMs) reported and was dependent on pretreatment function, T-classification, and tumor volume. Future investigations should include optimal OMs to be used in the postoperative setting to allow for conclusive comparisons.
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Affiliation(s)
- Sarah E Stephen
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jennifer M Murphy
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Fiona R Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Diane Sellstrom
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Vinidh Paleri
- Head and Neck Unit, Royal Marsden Hospital, London, UK
| | - Joanne M Patterson
- School of Health Sciences, Liverpool Head and Neck Cancer Centre, University of Liverpool, Liverpool, UK
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13
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Melgaço SDA, Vicente LCC, Gama ACC. Analysis of decannulation time and oral intake recovery in oral cancer patients. Codas 2021; 33:e20190236. [PMID: 34346947 DOI: 10.1590/2317-1782/20202019236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 10/12/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE to analyze the time of decannulation and oral diet release of patients undergoing oral cancer surgery at the Hospital Alberto Cavalcante and to verify which factors are associated with the time of decannulation and oral diet release. METHODS an observational study of the database of 33 adult patients surgically treated with oral cancer and served between 2012 and 2017. The socio-demographic variables (age and gender) and clinical variables (type of surgery, surgical extension, type of reconstruction, clinical conditions and times of decannulation and reintroduction of the oral route) were collected through electronic medical records analysis. Descriptive statistical analysis was performed with measures of central tendency, dispersion and proportions. For the association analysis, the non-parametric Mann-Whitney U test was used for independent samples. RESULTS of the 33 participants, male and elderly predominated, 69.8% underwent resection of more than one structure. The median time of decannulation among patients with oral cancer was 8 days, and oral clearance of 9.5 days. Resections with more than one structure, the presence of fistula and dehiscence interfered in the oral release time. CONCLUSION the median time of decannulation was eight days and oral release time of 9.5 days. Resections with more than one structure, the presence of fistula, and suture dehiscence are associated with increased oral release time.
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Affiliation(s)
- Silmara de Abreu Melgaço
- Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
| | - Laelia Cristina Caseiro Vicente
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
| | - Ana Cristina Côrtes Gama
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
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14
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Nagatsuka H, Kawakami S, Kuwahara M, Kubota C, Kodama N, Minagi S. Newly designed flat surface artificial tongue system for speech improvement in glossectomy patients: A preliminary study. J Prosthodont Res 2021; 66:87-92. [PMID: 34261846 DOI: 10.2186/jpr.jpr_d_20_00230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To design an efficient tongue prosthesis with reproducibility and to objectively evaluate improvement in speech function. METHODS A silicon anatomical artificial tongue (AT) and a flat surface artificial tongue system (FTS) were used in our study. Twenty healthy participants (10 males and 10 females, 26.3 ± 1.8 years) were fitted with a tongue movement suppression appliance (TSA) that fit the dental arch to simulate the glossectomy condition. TSA, TSA + FTS, and TSA + AT simulated the state of glossectomy patients without artificial tongue, with normal artificial tongue, and newly designed artificial tongue, respectively. Three speech intelligibility tests were performed for each of the following conditions: pronouncing 100 Japanese monosyllables, 40 Japanese words, and reading a short story. One-way ANOVA, Wilcoxon signed-rank test, and Tukey-Kramer post-hoc test were used for statistical analyses. RESULTS Significant differences were observed for 100 Japanese monosylla bles and 40 Japanese words between the TSA + FTS, TSA, and TSA + AT conditions (p ‹ 0.05). Regarding the speech intelligibility test for reading a short story, the TSA + FTS condition resulted in a significantly higher speech intelligibility than the TSA and TSA + AT conditions (p ‹ 0.05). CONCLUSIONS A flat surface artificial tongue system contributed to the improvement in speech function. This structure can be easily used in cases where conventional artificial tongue are applicable, regardless of variation in the oral condition; thus, making it a widely applicable treatment option for glossectomy patients.
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Affiliation(s)
- Hiroaki Nagatsuka
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Shigehisa Kawakami
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Miho Kuwahara
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Chie Kubota
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Naoki Kodama
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Shogo Minagi
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
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15
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Functional Outcomes of the Medial Sural Artery Perforator Flap in Oral Cavity Reconstruction. Ann Plast Surg 2021; 85:256-259. [PMID: 32205498 DOI: 10.1097/sap.0000000000002352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The medial sural artery perforator (MSAP) flap is an ideal option for reconstruction of oral cavity defects owing to its thin and pliable nature and favorable donor site. Our study presents an assessment of functional outcomes including speech and swallowing in patients with oral cavity tumors reconstructed with MSAP flaps. METHODS Patients undergoing MSAP reconstruction for oral cavity tumors between January 2014 and January 2018 were identified from our prospective head and neck cancer database. Functional outcomes were assessed in conjunction with the Speech and Language Team with a minimum follow-up of 6 months. Function (speech and swallowing) was recorded as a performance status scale set up by the assessing health care professional. RESULTS A total of 38 patients underwent reconstruction with the MSAP flap over the study period. The patient cohort included 10 female patients and 28 male patients. The age range was from 30 to 78 years, with a mean age of 56.8 years. Complications included 1 flap loss and 1 donor site wound dehiscence.Most patients (84.2%) had intelligible speech at 6-month follow-up and further improvement at 1 year (92.1%). All patients resumed feeding on postoperative day 4, and only 7.8% (n = 3) of the patients required assistance with feeding at 1-year follow-up. CONCLUSIONS The MSAP flap provides adequate small-volume replacement for oral cavity reconstructions. Our results indicate that most patients achieve a full diet with no restrictions by 1 year after reconstruction. Most of our patients demonstrated excellent speech with little or no need for repetition in conversation. Over the past few years, this has become the flap of choice for oral cavity reconstruction in our unit.
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de Vicente JC, Rúa-Gonzálvez L, Barroso JM, Fernández Del Valle-Fernández Á, de Villalaín L, Peña I, Cobo JL. Functional results of swallowing and aspiration after oral cancer treatment and microvascular free flap reconstruction: A retrospective observational assessment. J Craniomaxillofac Surg 2021; 49:959-970. [PMID: 33994072 DOI: 10.1016/j.jcms.2021.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/20/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022] Open
Abstract
This study aimed to assess the functional swallowing outcomes in cohort of oral cancer patients treated with tumor resection and reconstruction by means of microvascular free flaps. Duration from onset to the last examination was classified into three periods: less than 12 months, from 13 to 24 months, and more than 24 months. Type of feeding, dysphagia, and laryngeal aspiration were the dependent variables, and the study was mainly focused on the data from the multivariate analysis. Fifty-one patients were included in the study. Twenty-one patients had dysphagia, 11 showed stasis in vallecula and pyriform sinuses, 9 experienced laryngeal penetration, and 8 aspirations. Surgery combined with radiochemotherapy was associated with a higher prevalence of dysphagia (p = 0.03). Frequency of dysphagia was higher in the first year after treatment and less frequent after 24 months (p = 0.003). Dysphagia was associated with laryngeal penetration (p = 0.001), and this with aspiration (p < 0.0005). In conclusion, as it seems that the method of reconstruction has a major influence on swallowing, when there are relevant alternatives in the way the reconstruction is done, always the approach should be chosen that reduces dysphagia to a minimum.
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Affiliation(s)
- Juan Carlos de Vicente
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain; Department of Surgery, University of Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Instituto Universitario de Oncología Del Principado de Asturias (IUOPA), Universidad de Oviedo. C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain.
| | - Laura Rúa-Gonzálvez
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain
| | - José María Barroso
- Phoniatrician. Department of Rehabilitation, Hospital Universitario Central de Asturias, Oviedo, Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain
| | - Álvaro Fernández Del Valle-Fernández
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Instituto Universitario de Oncología Del Principado de Asturias (IUOPA), Universidad de Oviedo. C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain
| | - Lucas de Villalaín
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Instituto Universitario de Oncología Del Principado de Asturias (IUOPA), Universidad de Oviedo. C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain
| | - Ignacio Peña
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Instituto Universitario de Oncología Del Principado de Asturias (IUOPA), Universidad de Oviedo. C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain
| | - Juan Luis Cobo
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain
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Tamer R, Chen Y, Xu X, Xie C, Swai J. Short-Term Quality of Life, Functional Status, and Their Predictors in Tongue Cancer Patients After Anterolateral Thigh Free Flap Reconstruction: A Single-Center, Prospective, Comparative Study. Cancer Manag Res 2020; 12:11663-11673. [PMID: 33235497 PMCID: PMC7678467 DOI: 10.2147/cmar.s268912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the quality of life, functional status, and their predictors in tongue cancer patients up to three months after anterolateral thigh free flap (ALTFF) reconstruction. Patients and Methods Tongue cancer patients were examined before and one and three months after ALTFF reconstruction using three validated questionnaires: the MD Anderson Dysphagia Inventory (MDADI), Eating Assessment Tool (EAT-10), and Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N). Mean scores were compared using the Friedman test. Forward selection and backward elimination methods of multiple linear regression analysis were used to identify the predictors of quality of life and functional status using SPSS at a 95% significance level. Results The present study included 265 participants (88.68% males, mean age 46.7 ± 11.05 years). The mean MDADI and EAT-10 scores were highest at one month after the surgery and lowest at three months after the surgery (p < 0.05). The mean FACT-H&N score was lowest at one month after the surgery (p < 0.05); however, post hoc analysis revealed that the difference in the scores before and three months after the surgery was non significant (p > 0.05). Denture use, occupation, age, tumor site, illness duration, drinking habit, and diet predicted the patients' quality of life, while denture use, betel nut consumption, age, marital status, and diet predicted their functional status. Conclusion Although tongue cancer patients have a poor quality of life and functional status in the first month after ALTFF reconstruction, their quality of life and functional status improve thereafter. We recommend the implementation of swallowing training programs and case-oriented psychological interventions to assist patients in coping with temporary deterioration during the first month after the surgery.
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Affiliation(s)
- Roba Tamer
- Xiangya School of Nursing, Central South University, Changsha City, Hunan Province, People's Republic of China.,Department of Nursing, Hama University, Hama City, Syria
| | - Yongyi Chen
- Xiangya School of Nursing, Central South University, Changsha City, Hunan Province, People's Republic of China.,Department of Hospital Administration, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha City, Hunan Province, People's Republic of China
| | - Xianghua Xu
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha City, Hunan Province, People's Republic of China
| | - Chanjuan Xie
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha City, Hunan Province, People's Republic of China
| | - Joel Swai
- Department of Nephrology and Rheumatology, The Third Xiangya Hospital of Central South University, Changsha City, Hunan Province, People's Republic of China
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18
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Pyne JM, Dziegielewski PT, Constantinescu G, Dzioba A, O'Connell DA, Côté DWJ, Ansari K, Harris J, Conrad D, Makki FM, Hearn M, Biron VL, Seikaly H. The Functional & Quality of Life Outcomes of Total Glossectomy with Laryngeal Preservation. Laryngoscope Investig Otolaryngol 2020; 5:853-859. [PMID: 33134532 PMCID: PMC7585251 DOI: 10.1002/lio2.435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/01/2020] [Accepted: 07/11/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The tongue is an essential organ for human interaction, communication and survival. To date, there is a paucity of objective functional, patient reported, or quality of life outcomes of patients undergoing a total glossectomy with preservation of the larynx (TGLP). OBJECTIVE To examine prospectively collected objective, self-reported functional and quality of life (QOL) data in patients undergoing TGLP and free flap reconstruction. METHODS Sixteen TGLP patients were identified in the prospective head and neck cancer and functional outcomes database between January of 2009 and December 2017. Data collection included patient age, sex, performance status, TNM staging, diagnosis and adjuvant treatment. Swallowing and speech functions were measured and prospectively recorded pre- and postoperatively. Patient reported outcomes were measured with the Speech Handicap Index (SHI) and the M.D. Anderson Dysphagia Inventory (MDADI). RESULTS All patients had a significant reduction in their objective swallowing (P = 0.035), sentence (P = 0.001) and word intelligibility (P < .001) scores. There was no significant reduction in SHI or total MDADI scores. All patients maintained their QOL in the post-treatment time frame. There was no relationship between free-flap type and outcome. CONCLUSION Total glossectomy with laryngeal sparing and free flap reconstruction results in significant reduction in objective functional measurements, but patients report stable functional and quality of life outcomes after treatment.
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Affiliation(s)
- Justin M. Pyne
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | | | - Gabriela Constantinescu
- Institute for Reconstructive Sciences in MedicineCaritas Health GroupEdmontonAlbertaCanada
- Communication Sciences and DisordersUniversity of AlbertaEdmontonAlbertaCanada
| | - Agnieszka Dzioba
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Daniel A. O'Connell
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - David W. J. Côté
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Khalid Ansari
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Jeffrey Harris
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Dustin Conrad
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Fawaz M. Makki
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
- Department of Otolaryngology Head & Neck SurgeryKing Faisal Specialist Hospital & Research CenterRiyadhSaudi Arabia
| | - Matthew Hearn
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Vincent L. Biron
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Hadi Seikaly
- Department of Surgery, Division of Otolaryngology – Head and Neck SurgeryUniversity of AlbertaEdmontonAlbertaCanada
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Tran EK, Juarez KO, Long JL. Stem cell treatments for oropharyngeal dysphagia: Rationale, benefits, and challenges. World J Stem Cells 2020; 12:1001-1012. [PMID: 33033560 PMCID: PMC7524699 DOI: 10.4252/wjsc.v12.i9.1001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/28/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Dysphagia, defined as difficulty swallowing, is a common symptom negatively impacting millions of adults annually. Estimated prevalence ranges from 14 to 33 percent in those over age 65 to over 70 percent in a nursing home setting. The elderly, those with neurodegenerative diseases, head and neck cancer patients, and those with autoimmune conditions such as Sjögren's syndrome are disproportionately affected. Oropharyngeal dysphagia refers specifically to difficulty in initiating a swallow due to dysfunction at or above the upper esophageal sphincter, and represents a large proportion of dysphagia cases. Current treatments are limited and are often ineffective. Stem cell therapy is a new and novel advancement that may fill a much-needed role in our treatment regimen. Here, we review the current literature regarding stem cell treatments for oropharyngeal dysphagia. Topics discussed include tissue regeneration advancements as a whole and translation of these principles into research surrounding tongue dysfunction, xerostomia, cricopharyngeal dysfunction, and finally an overview of the challenges and future directions for investigation. Although this field of study remains in its early stages, initial promising results show potential for the use of stem cell-based therapies to treat oropharyngeal dysphagia and warrant further research.
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Affiliation(s)
- Eric K Tran
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, United States
| | - Kevin O Juarez
- Department of Otolaryngology, Yale School of Medicine, New Haven, CT 06511, United States
| | - Jennifer L Long
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, United States
- Greater Los Angeles VA Healthcare System, Los Angeles, CA 90073, United States
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20
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Polyakov AP, Mordovskiy AV, Ratushnyy MV, Rebrikova IV. Functional tongue and floor of mouth reconstruction with a chimeric flap after total glossectomy. Oral Maxillofac Surg 2020; 25:271-277. [PMID: 32926265 DOI: 10.1007/s10006-020-00907-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Presently, the functional reconstruction of the tongue in patients after subtotal or total glossectomy with the removal of the oral floor muscles and spearing of the larynx remains a complicated and unsolved issue. The aim of this case is to describe a method reconstruction of the tongue in patients after total glossectomy with the removal of the oral floor muscles using the chimeric latissimus dorsi and serratus anterior free flap (chimeric LD + SA flap) with motor innervation. METHODS A 62-year-old woman with advanced cancer of the oral cavity was submitted to total glossectomy and then reconstruction with a chimeric LD + SA flap. With this method reconstruction of the tongue was made the creation a large mound (neotongue) lateral to the mandibular arch which can easily reach the palatal arch and also was made suspension of the larynx is essential given the ablative loss of supra-hyoid attachments. RESULTS Our preliminary experience shows that this flap is a good reconstructive option for total glossectomy with the removal of the oral floor muscles and with larynx preservation. Functional and objective evaluation of the tongue reconstructed with chimeric LD + SA free flap requires further and standardized evaluation.
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Affiliation(s)
- Andrey P Polyakov
- P. Hertsen Moscow Oncology Research Institute, National Medical Research Center for Radiology, Russian Ministry of Health, 2-nd Botkinsky 3, Moscow, Russia
| | - Alexander V Mordovskiy
- P. Hertsen Moscow Oncology Research Institute, National Medical Research Center for Radiology, Russian Ministry of Health, 2-nd Botkinsky 3, Moscow, Russia.
| | - Mikhail V Ratushnyy
- P. Hertsen Moscow Oncology Research Institute, National Medical Research Center for Radiology, Russian Ministry of Health, 2-nd Botkinsky 3, Moscow, Russia
| | - Irina V Rebrikova
- P. Hertsen Moscow Oncology Research Institute, National Medical Research Center for Radiology, Russian Ministry of Health, 2-nd Botkinsky 3, Moscow, Russia
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21
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Zhou X, He ZJ, Su YX, Zhang S, Gong ZJ, Wu HJ. "Sushi roll" technique for precise total tongue functional reconstruction using a pre-sutured femoral anterolateral myocutaneous flap. Oral Oncol 2020; 110:104866. [PMID: 32623343 DOI: 10.1016/j.oraloncology.2020.104866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/12/2020] [Accepted: 06/15/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Reconstruction of the total tongue after cancer resection remains one of the challenges in head and neck surgery. Inadequate reconstruction after subtotal or total glossectomy defects leads to poor quality of life. The aim of this study was to explore an economical, practical and effective flap design for functional tongue reconstruction. MATERIAL AND METHODS Sixty patients were randomly divided into two groups, namely, a "Sushi roll" technique group (30 patients) and a conventional surgery group (30 patients). Then, the patients underwent total or subtotal tongue reconstruction. Swallowing function, speech intelligibility, cosmetic results, and quality of life were assessed with the appropriate scales. Outcomes were analysed, and a p-value <0.05 was considered significant. RESULTS The perioperative recovery of the "Sushi roll" group was superior to that of the conventional group. Relative to patients in the conventional group, patients in the "Sushi roll" group showed significantly improved speech intelligibility (p = 0.025), cosmetic results (p < 0.001) and swallowing function (p < 0.001). CONCLUSION The innovative "Sushi roll" anterolateral thigh myocutaneous flap approach for total tongue reconstruction creates a free neotongue tip with adequate volume and protuberance and causes minimal damage to the donor site, producing acceptable swallowing function and speech intelligibility.
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Affiliation(s)
- Xi Zhou
- Lecturer, Discipline of Oral & Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Zhi-Jing He
- Lecturer, Discipline of Oral & Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yu-Xiong Su
- Associate Professor, Discipline of Oral & Maxillofacial Surgery, Faculty of Dentistry, the University of Hong Kong, Hong Kong, China
| | - Sheng Zhang
- Professor and Chief, Discipline of Oral & Maxillofacial Surgery, The Second Xiangya hospital, Central South University, Changsha, China
| | - Zhao Jian Gong
- Associate Professor, Discipline of Oral & Maxillofacial Surgery, The Second Xiangya hospital, Central South University, Changsha, China
| | - Han Jiang Wu
- Professor and Chief, Discipline of Oral & Maxillofacial Surgery, The Second Xiangya hospital, Central South University, Changsha, China
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Ferrari M, Sahovaler A, Chan HH, Nicolai P, Irish JC, Gilbert RW. Scapular tip-thoracodorsal artery perforator free flap for total/subtotal glossectomy defects: Case series and conformance study. Oral Oncol 2020; 105:104660. [DOI: 10.1016/j.oraloncology.2020.104660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/08/2020] [Accepted: 03/18/2020] [Indexed: 12/09/2022]
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23
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Katna R, Bhosale B, Sharma R, Singh S, Deshpande A, Kalyani N. Oncological outcomes in patients undergoing major glossectomy for advanced carcinoma of the oral tongue. Ann R Coll Surg Engl 2020; 102:514-518. [PMID: 32436723 DOI: 10.1308/rcsann.2020.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Major glossectomy is the treatment of choice in locally advanced tongue cancer. It remains the only option in the presence of recurrent or residual disease. The long-term outcomes for patients undergoing major glossectomy have traditionally been poor, with significant morbidity and poor oncological outcomes. The aim of this study was to report on oncological outcomes in patients undergoing major glossectomy. METHODS All patients undergoing major glossectomy between 2014 and 2018 were included in the study. The data of 85 patients with advanced carcinoma of the oral tongue were evaluated. All were under the care of a single surgical and reconstructive team at two hospitals in Mumbai. RESULTS The median patient age was 45 years. At the most recent follow-up, 55 patients (65%) were alive, 47 of whom were disease free. Twenty-nine patients (34%) had locoregional recurrence and twenty-five (29%) had distant metastasis. At a median follow-up of 19 months, rates for 2-year locoregional control, disease free survival (DFS) and overall survival (OS) were 69%, 61% and 62% respectively. Perinodal extension demonstrated a trend towards poor DFS (p=0.060), as did perineural invasion (p=0.055). Node positivity was a significant factor for poor OS, DFS and locoregional control. Multiple node involvement was significantly associated with poor OS on multivariate analysis (p=0.002). CONCLUSIONS Node positivity and multiple node involvement were associated with poor outcomes. Major glossectomy may be offered as a curative option for selected patients with advanced carcinoma of the oral tongue with node negative or limited neck nodal disease (N1).
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Affiliation(s)
- R Katna
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Medical Research Centre, Mumbai, India
| | - B Bhosale
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Medical Research Centre, Mumbai, India
| | - R Sharma
- Bombay Hospital and Medical Research Centre, Mumbai, India
| | - S Singh
- Bombay Hospital and Medical Research Centre, Mumbai, India
| | - A Deshpande
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Medical Research Centre, Mumbai, India
| | - N Kalyani
- Jaslok Hospital and Research Centre, Mumbai, India
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Kekatpure V, Neelakantan V, Shetkar G. Total glossectomy: Technique review. JOURNAL OF HEAD & NECK PHYSICIANS AND SURGEONS 2020. [DOI: 10.4103/jhnps.jhnps_23_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Beavertail modification of the radial forearm free flap in total oral glossectomy reconstruction: Technique and functional outcomes. Oral Oncol 2019; 96:71-76. [DOI: 10.1016/j.oraloncology.2019.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/14/2019] [Accepted: 07/05/2019] [Indexed: 11/22/2022]
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26
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Klingelhöffer C, Obst A, Ettl T, Meier J, Müller S, Reichert T, Spanier G. Severe postoperative dysphagia as an early predictor for decreased overall survival in patients with oral cancer. J Craniomaxillofac Surg 2019; 47:1363-1369. [DOI: 10.1016/j.jcms.2019.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/26/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022] Open
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27
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Baskin RM, Seikaly H, Sawhney R, Danan D, Burt M, Idris S, Shama M, Boyce B, Dziegielewski PT. Tongue reconstruction: Rebuilding mobile three-dimensional structures from immobile two-dimensional substrates, a fresh cadaver study. Head Neck 2019; 41:3693-3699. [PMID: 31347741 DOI: 10.1002/hed.25889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/13/2019] [Accepted: 07/11/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To determine the two-dimensional (2D) characteristics of flaps necessary to create three-dimensional (3D) tongue anatomy. METHODS Dissection of 11 fresh, nonpreserved human cadavers was performed. Six defects in each were created: total tongue, total oral tongue, hemiglossectomy, oral hemiglossectomy, total base of tongue, and hemi-base of tongue. The resections were debulked to create flat, 2D mucosal flaps. The dimensions and shapes of these flaps were determined. RESULTS Each specimen showed consistent dimensions and geometry between cadavers. The total tongue was pear-shaped, the total oral tongue was egg-shaped, the oral hemi-tongue was bullet-shaped, the hemi-tongue resembled a dagger, the total base of tongue was rectangular, and the hemi-base of tongue was hour-glass shaped. CONCLUSION Typical dimensions and shapes of common tongue defects were determined. It is conceivable that customizing reconstructive flaps based on these data will increase the accuracy of neo-tongue reconstruction, and thus, improve functional outcomes.
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Affiliation(s)
- R Michael Baskin
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Raja Sawhney
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Deepa Danan
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Martha Burt
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Sherif Idris
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed Shama
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Brian Boyce
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida.,Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.,University of Florida Health Cancer Center, Gainesville, Florida
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28
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Chen DW, Wang T, Shey-Sen Ni J, Sandulache VC, Graboyes EM, Worley M, Hornig JD, Skoner JM, Day TA, Huang AT. Prognostic factors associated with achieving total oral diet after glossectomy with microvascular free tissue transfer reconstruction. Oral Oncol 2019; 92:59-66. [PMID: 31010625 PMCID: PMC6510264 DOI: 10.1016/j.oraloncology.2019.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/02/2019] [Accepted: 03/06/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Primary surgery followed by adjuvant therapy is the current standard of care in the multidisciplinary management of squamous cell carcinoma (SCC) of the oral tongue. Additionally, salvage glossectomy is used to treat recurrent base of tongue SCC. Microvascular free tissue transfer reconstruction (MVFTT) is utilized to maximize functional outcomes such as swallowing. We sought to identify prognostic factors related to achievement of a total oral diet in patients that underwent glossectomy with MVFTT. METHODS Retrospective review at a tertiary care center from 2010 to 2015. RESULTS 200 patients (69% male, mean age 60 years) met inclusion criteria. Extent of glossectomy was categorized as partial or hemiglossectomy (39%), tongue base resection with or without hemi-oral glossectomy (23%), composite resection with mandibulectomy (18%), and subtotal or total glossectomy (21%). Flap success rate was 96%. Median follow-up time was 14 months. A total oral diet was achieved by 49% of patients with median time to achievement of 31 days (IQR 9-209). Multivariate analysis identified body mass index < 25 kg/m2, prior radiation therapy, adjuvant chemoradiation, and resection requiring subtotal or total glossectomy or concurrent mandibulectomy as independent risk factors for worse total oral diet achievement. CONCLUSION Swallowing dysfunction represents a significant morbidity following glossectomy in the treatment of SCC. High BMI, smaller resection fields, and absence of prior radiation therapy or adjuvant chemoradiotherapy correlated with improved likelihood of obtaining a total oral diet. Patients should be appropriately counseled of this risk with emphasis placed on aggressive swallow rehabilitation in the post- treatment setting.
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Affiliation(s)
- Diane W Chen
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Tao Wang
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Jonathan Shey-Sen Ni
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Evan M Graboyes
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Mitchell Worley
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Joshua D Hornig
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Judith M Skoner
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Terry A Day
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Andrew T Huang
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States.
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29
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Quinsan IDCM, Costa GC, Priante AVM, Cardoso CA, Nunes CLS. Functional outcomes and survival of patients with oral and oropharyngeal cancer after total glossectomy. Braz J Otorhinolaryngol 2019; 86:545-551. [PMID: 30956152 PMCID: PMC9422732 DOI: 10.1016/j.bjorl.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/10/2018] [Accepted: 02/11/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Cancer of the oral cavity and oropharynx presents aggressive behavior and its diagnosis is, in most cases, performed in advanced stages. Total glossectomy is a therapeutic option in locally advanced cancer, and the only one in the recurrent or residual disease, after chemoradiotherapy. OBJECTIVE To evaluate the clinical-epidemiological profile, postoperative complications, survival rates and functional aspects of patients with oral cavity and oropharynx cancer after total glossectomy. METHODS It was a retrospective study where 22 patients were included with oral cavity and oropharyngeal cancer after total glossectomy at the Hospital Regional do Vale do Paraíba, em Taubaté, São Paulo. RESULTS All patients were male, with a median age of 57 years, most of tumors are located in the tongue and floor of the mouth and classified as stage IVa. Total glossectomy as initial treatment was performed in 18 and as salvage in four patients. The major pectoralis myocutaneous flap was used for reconstruction in all cases. The main postoperative complication was wound infection and salivary fistula. CONCLUSION Overall survival was 19% and cancer-specific survival was 30.8% in five years. Eight patients were rehabilitated for exclusive oral feeding without the dependence tracheostomy and enteral tube, all with an overall survival greater than 15 months.
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30
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Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, Kim MS, Kim JK, Kim H, Nam I, Roh JL, Park YM, Park IS, Park JJ, Shin SC, Ahn SH, Won S, Ryu CH, Yoon TM, Lee G, Lee DY, Lee MC, Lee JK, Lee JC, Lim JY, Chang JW, Jang JY, Chung MK, Jung YS, Cho JG, Choi YS, Choi JS, Lee GH, Chung PS. Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2019; 12:107-144. [PMID: 30703871 PMCID: PMC6453784 DOI: 10.21053/ceo.2018.01816] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient’s treatment goals.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Bon Seok Koo
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology Head and Neck Surgery, CHA University School of Medicine, Seongnam, Korea
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Innchul Nam
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jung Je Park
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seongjun Won
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Tae Mi Yoon
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Giljoon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Chul Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Joon Kyoo Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeon Yeob Jang
- Department of Otorhinolaryngology Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yuh-Seok Jung
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeong-Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Inha University School of Medicine, Incheon, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Phil-Sang Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
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Abstract
The tongue is paramount to natural speech and swallowing, and good tongue function is important in the overall quality of life. Autologous free-flap reconstruction of the tongue after glossectomy allows for adequate speech, swallow, and quality-of-life outcomes in a majority of patients. Herein, the authors review autologous free-flap reconstruction of the tongue with a focus on different flap options, speech and swallow outcomes, quality-of-life outcomes, and factors that affect how patients perform after tongue reconstruction.
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Affiliation(s)
- Aurora Vincent
- Otolaryngology - Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Scott Kohlert
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Thomas S. Lee
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University Hospital, Richmond, Virginia
| | - Jared Inman
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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32
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Han AY, Kuan EC, Mallen-St Clair J, Badran KW, Palma Diaz MF, Blackwell KE, St John MA. Total Glossectomy With Free Flap Reconstruction: Twenty-Year Experience at a Tertiary Medical Center. Laryngoscope 2019; 129:1087-1092. [PMID: 30667056 DOI: 10.1002/lary.27579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To characterize the demographics, clinicopathologic characteristics, and treatment and reconstructive outcomes of patients who underwent total glossectomy STUDY DESIGN: Retrospective chart review at an academic tertiary-care medical center. METHODS All patients who had undergone total glossectomy (as an individual procedure or as part of a more extensive resection) between January 1, 1995 and December 31, 2014 were included in the analysis. Patient characteristics and clinical outcomes were reviewed. RESULTS Forty-eight patients underwent total glossectomy for oral tongue and base of tongue cancer. The mean age of the patients was 56 (range, 29-92 years). History of tobacco and heavy alcohol use was found in 76% and 11% of patients, respectively. The majority of patients had advanced cancer (91.7% at stage IV), and 60.4% had salvage therapy for recurrent disease. T4 disease comprised 81% of patients. Sixty percent had clinical or radiographic evidence of nodal metastasis. Reconstruction of the defect was performed with free flaps from the rectus abdominus (40%), fibula (25%), anterolateral thigh (23%), and other donor tissues. One- and 5-year survival rates were 42% and 26%, with locoregional and distant recurrence reported at 36% and 25%, respectively. CONCLUSIONS Total glossectomy for oncologic control is most commonly performed in patients who have stage IV cancers. Despite high reconstructive success rates, the likelihood of locoregional and distance recurrence was high. Most patients can communicate intelligibly and achieve decannulation, but swallowing outcomes remain guarded, especially considering previous irradiation and resection of the base of tongue. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1087-1092, 2019.
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Affiliation(s)
- Albert Y Han
- Department of Head and Neck Surgery, Los Angeles, California
| | - Edward C Kuan
- Department of Head and Neck Surgery, Los Angeles, California
| | - Jon Mallen-St Clair
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco Medical Center, San Francisco, California, U.S.A
| | - Karam W Badran
- Department of Head and Neck Surgery, Los Angeles, California
| | | | - Keith E Blackwell
- Department of Head and Neck Surgery, Los Angeles, California.,University of California, Los Angeles Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California
| | - Maie A St John
- Department of Head and Neck Surgery, Los Angeles, California.,Jonsson Comprehensive Cancer Center, Los Angeles, California.,University of California, Los Angeles Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California
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Janik S, Pyka J, Stanisz I, Wachholbinger T, Leonhard M, Roesner I, Denk-Linnert DM, Miles BA, Schneider-Stickler B, Erovic BM. Use of the myocutaneous serratus anterior free flap for reconstruction after salvage glossectomy. Eur Arch Otorhinolaryngol 2018; 276:559-566. [PMID: 30552516 PMCID: PMC6394427 DOI: 10.1007/s00405-018-5245-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/08/2018] [Indexed: 11/29/2022]
Abstract
Purpose To describe the use of a myocutaneous serratus anterior free flap (SAFF) for tongue reconstruction after salvage subtotal (STG) and total glossectomy (TG). Methods In this prospective case series, seven patients underwent salvage STG or TG and reconstruction with a myocutaneous SAFF between 10/2015 and 02/2017. Functional and oncologic outcomes were prospectively evaluated. Donor side morbidity was determined using the Disabilities of the Arm, Shoulder and Hand (DASH) score. Results SAFF with mean skin paddles of 6.7 cm × 8.7 cm was used in five STG and two TG patients, respectively. There was a 100% flap survival and a mean DASH score of 10.8 reflected normal arm and shoulder function after surgery. One year after salvage surgery, 1 (14.3%) and 4 (57.1%) patients were tracheostomy and gastrostomy tube dependent. Gastrostomy tube dependence was significantly worse in patients with tumors of the base of tongue compared to other tumor sites (p = 0.030) and in patients who underwent transcervical compared to transoral tumor resection (p = 0.008). Local recurrence rate was 57.1% with a disease-free survival of 17.6 months. Conclusion The myocutaneous SAFF represents a safe and reliable flap for tongue reconstruction after salvage glossectomy with satisfying functional outcomes and low donor side morbidity.
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Affiliation(s)
- Stefan Janik
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Julian Pyka
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Isabella Stanisz
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Tamara Wachholbinger
- Division of Phoniatrics-Logopedics, Department of Otolaryngology, Medical University of Vienna, Vienna, Austria
| | - Matthias Leonhard
- Division of Phoniatrics-Logopedics, Department of Otolaryngology, Medical University of Vienna, Vienna, Austria
| | - Imme Roesner
- Division of Phoniatrics-Logopedics, Department of Otolaryngology, Medical University of Vienna, Vienna, Austria
| | - Doris-Maria Denk-Linnert
- Division of Phoniatrics-Logopedics, Department of Otolaryngology, Medical University of Vienna, Vienna, Austria
| | - Brett A Miles
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Berit Schneider-Stickler
- Division of Phoniatrics-Logopedics, Department of Otolaryngology, Medical University of Vienna, Vienna, Austria
| | - Boban M Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria.
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Righini S, Festa BM, Bonanno MC, Colombo V, Luca N. Dynamic tongue reconstruction with innervated gracilis musculocutaneos flap after total glossectomy. Laryngoscope 2018; 129:76-81. [DOI: 10.1002/lary.27176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Stefano Righini
- Department of Head and Neck Oncologic and Reconstructive Surgery; San Giuseppe Hospital-Multimedica Group
| | | | | | - Valeria Colombo
- Department of Head and Neck Oncologic and Reconstructive Surgery; San Giuseppe Hospital-Multimedica Group
| | - Nicola Luca
- Department of Head and Neck Oncologic and Reconstructive Surgery; San Giuseppe Hospital-Multimedica Group
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35
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A Novel Laryngeal Preservation Technique following Total Glossectomy with Hyoid Bone Resection. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1756. [PMID: 29876189 PMCID: PMC5977942 DOI: 10.1097/gox.0000000000001756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/16/2018] [Indexed: 11/25/2022]
Abstract
Despite the recent progress of chemotherapy and sophisticated radiotherapy, surgery still remains the most reliable treatment for advanced tongue cancers in terms of survival. The major disadvantage of this treatment is that it should sacrifice the quality of patients' life. When the tongue cancer is so advanced as to involve the hyoid bone, which is considered a functional part of the larynx, radical operation needs to resect both the entire tongue and the larynx and the hyoid bone en bloc to prevent aspiration pneumonia. As a result of total laryngectomy, the patients will suffer significant disabilities: aphonia and the loss of deglutition that limits the oral intake to only liquid or pasty food. With this clinical background, we have been contriving to overcome these significant surgical shortcomings by conducting larynx-preserving operation. In this case report, we present our newly devised surgical method which consists of free-flap transfer with a combination of laryngeal suspension and a novel reconstructive technique, that is, epiglottis suspension, which enabled favorable swallowing function without aspiration and allowed a sufficiently wide airway for breathing. The operation worked quite successfully for the patient's quality of life. We believe this novel surgical method would serve as a larynx-preservation treatment for locally advanced tongue cancers with hyoid bone invasion.
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Nguyen KA, Bui TX, Van Nguyen H, Wein RO. Progressive functional improvement in hemiglossectomy defects reconstructed with radial forearm free flap at 6-months. Am J Otolaryngol 2018; 39:317-320. [PMID: 29544671 DOI: 10.1016/j.amjoto.2018.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/06/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purposes of the study was to evaluate for the functional improvement of outcomes of patients undergoing surgical management for tongue cancer at varying periods after surgery. DESIGN Case series with intervention. PARTICIPANTS Thirty consecutive patients, from 2011 to 2015, with carcinoma of the tongue undergoing surgical resection and reconstruction with a radial forearm free flap. MAIN MEASURES The Speech Intelligibility Test (SIT) is used for objective evaluation of speech function. The 7-point ordinal scale Functional Oral Intake Score (FOIS) was used to estimate the swallowing function. RESULTS The patients included were 25 men and 5 women with a mean age of 50.4 years (range - 27-65). All tumors were squamous cell carcinomas and all patients underwent a hemiglossectomy. There were two complete flap failures, with a resultant flap success rate of 93.3%. The initial mean speech intelligibility scores at 1-month increased from 72.3 ± 0.2 to 77.7 ± 8.9 at 6-months after surgery (p = 0.05). Similarly, the mean score of swallowing function improved from 6.1 at 1-month to 6.8 at 6-months after surgery (p = 0.05). CONCLUSION Reconstruction of hemiglossectomy defects with a radial forearm free flap offers functional benefits in speech and deglutition that demonstrate progressive improvement when 1- and 6-month post-surgical assessments are compared.
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Affiliation(s)
| | | | - Hue Van Nguyen
- Faculty of Social Sciences and Humanities, Ton Duc Thang University, Viet Nam
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Dong A, Zuo KJ, Papadopoulos-Nydam G, Olson JL, Wilkes GH, Rieger J. Functional outcomes assessment following free muscle transfer for dynamic reconstruction of facial paralysis: A literature review. J Craniomaxillofac Surg 2018; 46:875-882. [DOI: 10.1016/j.jcms.2018.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/20/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022] Open
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Foster CC, Melotek JM, Brisson RJ, Seiwert TY, Cohen EEW, Stenson KM, Blair EA, Portugal L, Gooi Z, Agrawal N, Vokes EE, Haraf DJ. Definitive chemoradiation for locally-advanced oral cavity cancer: A 20-year experience. Oral Oncol 2018; 80:16-22. [PMID: 29706184 DOI: 10.1016/j.oraloncology.2018.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/14/2018] [Accepted: 03/12/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Definitive chemoradiation (CRT) for oral cavity squamous cell carcinoma (OC-SCC) is often criticized for poor efficacy or toxicity. We describe a favorable 20-year experience of primary CRT for locally-advanced OC-SCC. MATERIALS AND METHODS Patients with locally-advanced, stage III/IV OC-SCC receiving primary concomitant CRT on protocols from 1994 to 2014 were analyzed. Chemotherapy included fluorouracil and hydroxyurea with other third agents. Radiotherapy (RT) was delivered once or twice daily to a maximum dose of 70-75 Gy. Intensity-modulated RT (IMRT) was exclusively used after 2004. Progression-free survival (PFS), overall survival (OS), locoregional control (LRC), and distant control (DC) were calculated by the Kaplan-Meier method and compared across treatment decades using the log-rank test. Rates of osteoradionecrosis (ORN) requiring surgery were compared across treatment decades using the Chi-square test. RESULTS 140 patients with locally-advanced OC-SCC were treated with definitive CRT. Of these, 75.7% had T3/T4 disease, 68.6% had ≥N2 nodal disease, and 91.4% had stage IV disease. Most common primary sites were oral tongue (47.9%) and floor of mouth (24.3%). Median follow-up was 5.7 years. Five-year OS, PFS, LRC, and DC were 63.2%, 58.7%, 78.6%, and 87.2%, respectively. Rates of ORN and long-term feeding tube dependence were 20.7% and 10.0%, respectively. Differences in LRC (P = 0.90), DC (P = 0.24), PFS (P = 0.38), OS (P = 0.10), or ORN (P = 0.38) were not significant across treatment decades. CONCLUSION Definitive CRT is a viable and feasible strategy for organ preservation for patients with locally-advanced OC-SCC.
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Affiliation(s)
- Corey C Foster
- Department of Radiation and Cellular Oncology, University of Chicago, 5758 S. Maryland Avenue, M/C 9006, Chicago, IL 60637, USA
| | - James M Melotek
- Department of Radiation and Cellular Oncology, University of Chicago, 5758 S. Maryland Avenue, M/C 9006, Chicago, IL 60637, USA
| | - Ryan J Brisson
- Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI 48309, USA
| | - Tanguy Y Seiwert
- Department of Medicine and Comprehensive Cancer Center, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Ezra E W Cohen
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
| | - Kerstin M Stenson
- Department of Otolaryngology, Rush University, 1611 W. Harrison Street, Suite 550, Chicago, IL 60612, USA
| | - Elizabeth A Blair
- Department of Otolaryngology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Louis Portugal
- Department of Otolaryngology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Zhen Gooi
- Department of Otolaryngology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Nishant Agrawal
- Department of Otolaryngology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Everett E Vokes
- Department of Medicine and Comprehensive Cancer Center, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Daniel J Haraf
- Department of Radiation and Cellular Oncology, University of Chicago, 5758 S. Maryland Avenue, M/C 9006, Chicago, IL 60637, USA.
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Suzuki H, Hyodo I, Hasegawa Y. Prediction of decannulation, oral intake recovery, overall survival and lung metastasis following oral malignant tumor resection and reconstruction. Oncol Lett 2018; 15:2686-2694. [PMID: 29434993 DOI: 10.3892/ol.2017.7585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/21/2017] [Indexed: 11/05/2022] Open
Abstract
The present study investigated whether tongue base and mandibular bone defects were associated with the rate of decannulation and oral intake recovery, and survival time, including overall and lung metastasis-free survival time, in patients that underwent oral malignant tumor (OMT) resection with reconstruction. A total of 105 patients that underwent OMT resection with laryngeal preservation and reconstruction were recruited. The extent of defects was classified according to Urken's classification. The rates of decannulation and oral intake recovery were assessed with the Kaplan-Meier method. It was identified that 4-5 section segmental mandibulectomy (SM) and total glossectomy (TG) were significantly associated with a lower rate of decannulation and oral intake recovery by univariate and multivariate analysis using a Cox's proportional model. Patients in the high risk group (4-5 sections or TG) were significantly less likely to achieve decannulation and unaided oral intake. Patients in the high risk group exhibited a significantly shorter overall and lung metastasis-free survival time. Following multivariate analysis adjusted for the clinical stage (IV/I-III), past history of or postoperative radiotherapy (yes/no) and age (per year), the high risk group was associated with a significantly rate of decannulation and unaided oral intake. In conclusion, TG or wide SM is a prognostic parameter for functional and survival outcomes, including lung metastasis, in OMT.
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Affiliation(s)
- Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Ikuo Hyodo
- Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
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Keski-Säntti H, Bäck L, Lassus P, Koivunen P, Kinnunen I, Blomster H, Mäkitie AA, Aro K. Total or subtotal glossectomy with laryngeal preservation: a national study of 29 patients. Eur Arch Otorhinolaryngol 2017; 275:191-197. [DOI: 10.1007/s00405-017-4789-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022]
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Solomon NP, Makashay MJ, Helou LB, Clark HM. Neurogenic Orofacial Weakness and Speech in Adults With Dysarthria. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:951-960. [PMID: 28763804 PMCID: PMC5829797 DOI: 10.1044/2017_ajslp-16-0144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 03/07/2017] [Indexed: 05/16/2023]
Abstract
PURPOSE This study compared orofacial strength between adults with dysarthria and neurologically normal (NN) matched controls. In addition, orofacial muscle weakness was examined for potential relationships to speech impairments in adults with dysarthria. METHOD Matched groups of 55 adults with dysarthria and 55 NN adults generated maximum pressure (Pmax) against an air-filled bulb during lingual elevation, protrusion and lateralization, and buccodental and labial compressions. These orofacial strength measures were compared with speech intelligibility, perceptual ratings of speech, articulation rate, and fast syllable-repetition rate. RESULTS The dysarthria group demonstrated significantly lower orofacial strength than the NN group on all tasks. Lingual strength correlated moderately and buccal strength correlated weakly with most ratings of speech deficits. Speech intelligibility was not sensitive to dysarthria severity. Individuals with severely reduced anterior lingual elevation Pmax (< 18 kPa) had normal to profoundly impaired sentence intelligibility (99%-6%) and moderately to severely impaired speech (26%-94% articulatory imprecision; 33%-94% overall severity). CONCLUSIONS Results support the presence of orofacial muscle weakness in adults with dysarthrias of varying etiologies but reinforce tenuous links between orofacial strength and speech production disorders. By examining individual data, preliminary evidence emerges to suggest that speech, but not necessarily intelligibility, is likely to be impaired when lingual weakness is severe.
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Affiliation(s)
- Nancy Pearl Solomon
- National Military Audiology & Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD
| | - Matthew J. Makashay
- National Military Audiology & Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD
| | - Leah B. Helou
- National Military Audiology & Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD
- Systems Neuroscience Institute, University of Pittsburgh, PA
| | - Heather M. Clark
- Department of Neurology, Speech Pathology, Mayo Clinic, Rochester, MN
- Department of Communication Sciences and Disorders, Appalachian State University, Boone, NC
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Potential for low-value palliative care of patients with recurrent head and neck cancer. Lancet Oncol 2017; 18:e284-e289. [PMID: 28456588 DOI: 10.1016/s1470-2045(17)30260-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/22/2016] [Accepted: 01/05/2017] [Indexed: 12/25/2022]
Abstract
Curative treatment for patients with advanced head and neck cancer can be associated with many side-effects, and many patients suffer from persistent treatment-related side-effects. Patients with recurrent cancer bear the burden of these effects along with additional symptoms attributed to the recurrent tumour. To better understand the benefits and burden of palliative treatments for patients with recurrent head and neck cancer, we reviewed the evidence on commonly used palliative treatments and their effect on quality of life. When used for palliative care purposes, chemotherapy and radiotherapy have limited effectiveness in improving quality of life. Moreover, if these treatments are not congruent with a patient's end-of-life goals, they could constitute low-value care. We recommend that patients with advanced and recurrent cancer should be offered early, comprehensive palliative and supportive services to maximise benefit. The principles of beneficence and respect for patients in the context of shared decision making must prevail if the trust of this vulnerable patient population is to be honoured.
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Liu M, Liu W, Yang X, Guo H, Peng H. Pectoralis Major Myocutaneous Flap for Head and Neck Defects in the Era of Free Flaps: Harvesting Technique and Indications. Sci Rep 2017; 7:46256. [PMID: 28387356 PMCID: PMC5384233 DOI: 10.1038/srep46256] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/10/2017] [Indexed: 02/05/2023] Open
Abstract
The role of the pectoralis major myocutaneous flap (PMMF) in head and neck reconstruction is challenged recently due to its natural drawbacks and the popularity of free flaps. This study was designed to evaluate the indications and reliability of using a PMMF in the current free flap era based on a single center experience. The PMMF was harvested as a pedicle-skeletonized flap, with its skin paddle caudally and medially to the areola, including the third intercostal perforator, preserving the upper one third of the pectoralis major muscle. The harvested flap was passed via a submuscular tunnel over the clavicle. One hundred eighteen PMMFs were used in 114 patients, of which 76 were high-risk candidates for a free flap; 8 patients underwent total glossectomy, and 30 underwent salvage or emergency reconstruction. Major complications occurred in 4 patients and minor complications developed in 10. Tracheal extubation was possible in all cases, while oral intake was possible in all but 1 case. These techniques used in harvesting a PMMF significantly overcome its natural pitfalls. PMMFs can safely be used in head and neck cancer patients who need salvage reconstruction, who are high risk for free flaps, and who need large volume soft-tissue flaps.
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Affiliation(s)
- Muyuan Liu
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, Shantou, 515031, P. R. China
| | - Weiwei Liu
- Department of Head and Neck Surgery, Cancer Center, Sun Yat-sen University, Guangzhou, 510080, P. R. China
| | - Xihong Yang
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, Shantou, 515031, P. R. China
| | - Haipeng Guo
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, Shantou, 515031, P. R. China
| | - Hanwei Peng
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, Shantou, 515031, P. R. China
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Oral cavity and lip cancer: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology & Otology 2017; 130:S83-S89. [PMID: 27841120 PMCID: PMC4873943 DOI: 10.1017/s0022215116000499] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the assessment and management of patients with cancer of the oral cavity and the lip. Recommendations • Surgery remains the mainstay of management for oral cavity tumours. (R) • Tumour resection should be performed with a clinical clearance of 1 cm vital structures permitting. (R) • Elective neck treatment should be offered for all oral cavity tumours. (R) • Adjuvant radiochemotherapy in the presence of advanced neck disease or positive margins improves control rates. (R) • Early stage lip cancer can be treated equally well by surgery or radiation therapy. (R).
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Mayo Clinic Experience with Unfavorable Results After Free Tissue Transfer to Head and Neck. Clin Plast Surg 2016; 43:669-82. [DOI: 10.1016/j.cps.2016.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Li C, Lin J, Men Y, Yang W, Mi F, Li L. Does Medullary Versus Cortical Invasion of the Mandible Affect Prognosis in Patients With Oral Squamous Cell Carcinoma? J Oral Maxillofac Surg 2016; 75:403-415. [PMID: 27621147 DOI: 10.1016/j.joms.2016.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE Whether mandibular involvement by oral squamous cell carcinoma (OSCC) could be identified as a factor for cancer staging and prognosis prediction remains a subject of debate. In addition, the influence of different types of mandibular invasion (cortical or medullary invasion) on patients' prognosis remains unclear. The aim of this systematic review was to establish whether mandibular invasion or its subset should be considered an independent prognostic factor for patients with OSCC. MATERIALS AND METHODS The search for eligible studies was performed according to the predesigned inclusion criteria for a systematic review. Mandibular invasion and invasion depth were considered the primary and secondary predictor variables, respectively. The electronic search was performed using 12 databases. Manual searching covered 14 related journals and references of the included studies were scanned. The risk of bias assessment was evaluated by 2 reviewers using risk-of-bias assessment tools recommended by Saltaji et al (Angle Orthod 82:1115, 2012). Two reviewers extracted the data in duplicate. RevMan 5.2 was used for meta-analysis to assess the primary outcomes (disease-free survival and overall survival) and the secondary outcomes (2- and 5-year survival rate and local control). RESULTS Eighteen studies (total, 3,756 participants) were included and used as the study sample. Among these included studies, 7 had an unclear risk of bias and the remaining showed a high risk. The results of the meta-analyses showed a significant relation between mandibular invasion and overall survival (P = .04) and, most importantly, that medullary involvement (P = .0001), but not cortical involvement (P = .66), could decrease overall survival. When focusing on disease-specific survival, mandibular medullary involvement predicted a poor disease-specific survival (P < .0001), but cortical involvement showed no effect (P = .66). CONCLUSION This review showed that OSCC mandibular medullary invasion, and not mandibular invasion or mandibular cortical invasion, could be an independent prognostic factor for patients.
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Affiliation(s)
- Chunjie Li
- Associate Professor, Departments of Head and Neck Oncology and Evidence-Based Dentistry, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Jie Lin
- Attending Physician, Department of Dental Anesthesiology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Yi Men
- Attending Physician and Lecturer, Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Wenbin Yang
- PhD Candidate, Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Fanglin Mi
- Professor and Department Head, Department of Stomatology, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Longjiang Li
- Professor and Department Director, Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.
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Longitudinal and long-term effects of radiotherapy on swallowing function after tongue reconstruction. The Journal of Laryngology & Otology 2016; 130:865-72. [DOI: 10.1017/s0022215116008720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:This study evaluated the longitudinal and long-term effects of radiotherapy on swallowing function after tongue reconstruction.Methods:The study comprised 16 patients who had: undergone glossectomy and tongue reconstruction with free flap transfer, received adjuvant radiotherapy, and survived without recurrence for at least 1 year. Swallowing function, as indicated by tolerance of oral intake, was evaluated before radiotherapy, at radiotherapy completion, and at 6 and 12 months after radiotherapy completion.Results:Before radiotherapy, all patients could tolerate oral intake. At radiotherapy completion, only three patients could consume all nutrition orally. However, swallowing function improved over time, and by 12 months after radiotherapy completion it had returned nearly to that before radiotherapy.Conclusion:Acute dysphagia due to radiotherapy after tongue reconstruction is severe, but can improve gradually. Multidisciplinary support of patients during percutaneous endoscopic gastrostomy dependence is important to improve long-term functional outcomes.
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Okubo M, Iwai T, Nakashima H, Koizumi T, Oguri S, Hirota M, Mitsudo K, Tohnai I. Squamous Cell Carcinoma of the Tongue Dorsum: Incidence and Treatment Considerations. Indian J Otolaryngol Head Neck Surg 2016; 69:6-10. [PMID: 28239570 DOI: 10.1007/s12070-016-0979-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/02/2016] [Indexed: 11/26/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the tongue is the most common oral cancer. Most cases occur on the lateral border of the tongue and only very rarely on the dorsum. We retrospectively investigated the incidence of SCC of the tongue dorsum in our department between April 2006 and March 2015. Of the 368 patients with tongue cancer, only 3 had SCC of the tongue dorsum (incidence, 0.8 %). All patients with advanced cancer of the tongue dorsum underwent superselective intra-arterial chemoradiotherapy for organ preservation. We discuss the present findings in relation to past case reports and series in the English language literature as well as discuss treatments for SCC of the tongue dorsum.
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Affiliation(s)
- Makiko Okubo
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Yokohama, Kanagawa, 236-0004 Japan
| | - Toshinori Iwai
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Yokohama, Kanagawa, 236-0004 Japan
| | - Hideyuki Nakashima
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Yokohama, Kanagawa, 236-0004 Japan
| | - Toshiyuki Koizumi
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Yokohama, Kanagawa, 236-0004 Japan
| | - Senri Oguri
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Yokohama, Kanagawa, 236-0004 Japan
| | - Makoto Hirota
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Yokohama, Kanagawa, 236-0004 Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Yokohama, Kanagawa, 236-0004 Japan
| | - Iwai Tohnai
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Yokohama, Kanagawa, 236-0004 Japan
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Gangiti KK, Gondi JT, Nemade H, Sampathirao LCSR, Raju K, Rao TS. Modified pectoralis major myocutaneous flap for the total glossectomy defects: Effect on quality of life. J Surg Oncol 2016; 114:32-5. [DOI: 10.1002/jso.24260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/31/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Kranthi Kumar Gangiti
- Department of Surgical Oncology; Basavatarakam Indo American Cancer Hospital and Research Institute; Hyderabad India
| | - Jonathan T. Gondi
- Department of Surgical Oncology; Basavatarakam Indo American Cancer Hospital and Research Institute; Hyderabad India
| | - Hemantkumar Nemade
- Department of Surgical Oncology; Basavatarakam Indo American Cancer Hospital and Research Institute; Hyderabad India
| | | | - K.V.V.N. Raju
- Department of Surgical Oncology; Basavatarakam Indo American Cancer Hospital and Research Institute; Hyderabad India
| | - T. Subramanyeshwar Rao
- Department of Surgical Oncology; Basavatarakam Indo American Cancer Hospital and Research Institute; Hyderabad India
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Paydarfar JA, Freed GL, Gosselin BJ. The anterolateral thigh fold-over flap for total and subtotal glossectomy reconstruction. Microsurgery 2016; 36:297-302. [PMID: 26880059 DOI: 10.1002/micr.30033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/19/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND We present a fold-over technique for total and subtotal glossectomy reconstruction utilizing the ALT flap with the goal of increasing soft tissue bulk. METHODS Retrospective review of total and subtotal glossectomy patients undergoing ALT fold-over flap reconstruction from January 2007 to December 2012. RESULTS Eight patients fit inclusion criteria. Average length of follow-up was 35 months. There were no flap failures. At last follow-up, no patients were tracheostomy dependent. Six out of 8 patients (75%) did not require a g-tube and were able to maintain their weight. Speech intelligibility was good in 6/8 patients (75%). CONCLUSIONS The ALT fold-over flap technique provides sufficient bulk to allow decannulation and airway protection as well as PO intake in most patients. Given the minimal donor site morbidity, it is our technique of choice for total and subtotal glossectomy defects. © 2016 Wiley Periodicals, Inc. Microsurgery 36:297-302, 2016.
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Affiliation(s)
- Joseph A Paydarfar
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Gary L Freed
- Division of Plastic Surgery, Department of Surgery, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Benoit J Gosselin
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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