Groin and anterolateral thigh flaps for hemiglossectomy reconstruction: A comparison based on Japanese speech intelligibility

OBJECTIVE

The differences in speech function between groin flap reconstruction and anterolateral thigh (ALT) flap reconstruction after hemiglossectomy have not been clarified to date. This study aimed to compare Japanese speech intelligibility after hemiglossectomy reconstruction using groin and ALT flaps of similar thickness.

METHODS

Data of patients who underwent hemiglossectomy reconstruction with groin or ALT flaps between April 2010 and March 2020 were collected from the medical chart database. The ALT flap was the first choice for hemiglossectomy reconstruction, and a groin flap was used when the ALT flap was >10 mm. Cases in which speech intelligibility assessments based on Hirose's 10-point scoring system, the TKR speech test, and the Japanese speech intelligibility test for 100 monosyllables were performed after 6 months postoperatively were extracted. The per-patient scores for each assessment were initially compared between the two flap groups. Then, the results of the Japanese speech intelligibility test for 100 monosyllables were reanalyzed on a syllable-by-syllable basis.

RESULTS

Among the 44 hemiglossectomy patients who underwent free-flap reconstruction during the study period, 14 (seven each in the groin flap and ALT flap groups) underwent all three conventional speech intelligibility assessments after 6 months postoperatively. The two groups showed no significant difference in postoperative speech intelligibility in any of the three patient assessment methods. However, in intergroup comparisons based on per-syllable accuracy for each of the 100 monosyllables, the groin flap group showed 19 syllables with a significantly higher accuracy, whereas the ALT flap group showed one such syllable. In particular, five out of the six alveolar consonants (/t/ and /d/) were more accurately articulated in the groin flap group. Per-syllable accuracy was significantly higher in the groin flap group (74.6% vs. 66.7%; 95% confidence interval: 4.6-11.1, p < 0.001).

CONCLUSION

In patients undergoing hemiglossectomy reconstruction, our new analysis method, which compared intelligibility by syllables, showed that the groin flap yielded higher speech intelligibility than the ALT flap. This difference was evident at all four articulation points involving the tongue, whereas there was no significant difference at the two articulation points without tongue involvement.

Assessment of Speech and Deglutition in Patients with Carcinoma Tongue Post Radial Forearm Free Flap Cover

Over the past 30 years, the introduction of reconstructive techniques incorporating microvascular free tissue transfer has transformed the quality of life of patients undergoing head and neck surgery.The free forearm flap was first described for head and neck reconstruction by Yang in 1981 when he used this flap to reconstruct a neck defect secondary to a burn scar contracture.In this retrospective cohort study, we have evaluated patients who underwent reconstruction of hemiglossectomy defect with radial forearm free flap for malignancy of tongue, from year 2018 to 2020, with reference to deglutition and speech.As per the data obtained, 41.7% and 50% of the patients had achieved excellently intelligible speech and moderately intelligible speech respectively whereas only 8.3% had poorly intelligible speech. On evaluation of post operative swallowing, 83.4% of the patients had excellent swallowing score and the remaining 16.6% had moderate and poor swallowing score.Hence, reconstruction of hemiglossectomy defects with radial forearm free flap is an excellent method to restore the functional outcomes in speech and deglutition.

Lateral position for difficult intubation in a patient with history of hemiglossectomy and flap reconstruction: a case report

Background

Reconstructive head and neck surgery can alter upper airway anatomy. We report a difficult intubation in a patient with a history of hemiglossectomy and reconstruction.

Case presentation

A 65-year-old female patient, who had undergone hemiglossectomy with the flap reconstruction, underwent video-assisted thoracoscopic esophagectomy for esophageal cancer. After the loss of consciousness during anesthesia induction, we failed to perform direct and oral fiberoptic intubation using a video laryngoscope and nasal fiberoptic intubation without or with video laryngoscope assistance in the supine position. Finally, shifting the patient to the left-lateral position allowed successful nasal fiberoptic intubation. Postoperatively, we were informed that she was unable to sleep in the supine position because of airway obstruction and therefore always slept on her side.

Conclusion

Preanesthetic evaluation of the influence of body position on the airway patency during sleep or sedation may aid in airway management.

Sensory recovery and oral health-related quality of life following tongue reconstruction using non-innervated radial forearm free flaps

OBJECTIVES

This study aimed to monitor the recovery of somatosensory function and oral health-related quality of life after tongue reconstruction using a non-innervated radial forearm free flap (RFFF).

METHODS

Twenty patients (9 men, age: 42-67 years) underwent tongue reconstruction with non-innervated RFFFs, and twenty age- and sex-matched controls were included in this study. Quantitative sensory testing (QST), including cold, warm, and mechanical detection thresholds (CDT, WDT, MDT); cold, heat, and mechanical pain thresholds (CPT, HPT, MPT); and static two-point, sharp/blunt, and direction discrimination (S2-PD, S/BD, DD) were determined 9 months and 18 months after surgery on the surgical (9 M, 18 M) and contralateral sides (9Mc, 18Mc). Oral Health Impact Profile-49 (OHIP-49) was used to determine the oral-related quality of life of participants.

RESULTS

All parameters showed significantly lower sensitivity at 9 M and 18 M (p < 0.001) compared to those for the controls and the contralateral side, except for DD (p = 0.101). In addition, the parameters showed a significant decrease in sensitivity for 9Mc and 18Mc (p ≤ 0.043) compared to those for the controls, except for MPT, HPT, S/SD, and DD (p ≥ 0.453). Findings on WDT, MPT, S2-PD, and DD (p ≤ 0.046) indicated significantly higher somatosensory function at 18 M than that at 9 M. MDT and MPT (p ≤ 0.038) showed significantly higher sensitivity at 18Mc than at 9Mc. Scores for all dimensions of OHIP-49 were significantly higher in patients (decrease in quality of life, p ≤ 0.002) than in controls, except for physical discomfort (p = 0.51). However, the scores were significantly higher at 18 M than at 9 M (p ≤ 0.011), except for handicap (p = 0.36). Postoperative chemotherapy was significantly correlated with impaired thermal sensitivity of the flaps (WDT, p = 0.049).

CONCLUSION

The present findings showed significant impairment in somatosensory function on both the surgical and contralateral sides of patients with RFFFs. However, a significant increase in somatosensory function was observed on both sides over time. Somatosensory disturbances observed after surgery were associated with poor oral health-related quality of life.

Stem cell treatments for oropharyngeal dysphagia: Rationale, benefits, and challenges

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.

Effect of size difference between hemiglossectomy and reconstruction flap on oral functions: A retrospective cohort study

BACKGROUND AND OBJECTIVE

Forearm free flaps are used after hemiglossectomy. However, no investigation has been performed on whether oral functions are better preserved when sizes of the resection and reconstruction flap are exact matches, or whether the size of the resection should be changed. We aimed to retrospectively examine whether size differences between the resection and reconstruction flap affect speech and swallowing functions postoperatively, and to determine whether there are more favorable flap size ratios.

METHODS

This is a retrospective cohort study of patients undergoing hemiglossectomy using a forearm free flap between 2006 and 2016 at Kobe University Hospital, Japan. The effect of size difference between the resection and reconstruction flap on maintained oral function was assessed. Speech and swallowing functions were assessed, and their correlation with the ratio of the flap size to that of the resected area was determined. With these data, distribution maps of the relationship between the functional level and reconstructed dimension ratio were prepared. The more suitable reconstructed dimension ratio was examined and evaluated. The Fisher exact test, Kruskal-Wallis test, and Scheffe test were used in statistical analyses.

RESULTS

Eighty-eight patients underwent hemiglossectomy using a forearm free flap during a 10-year period. Of these cases, 66 patients were included in this study, while 22 were excluded. The ratio of the area of the reconstruction flap to that of the resection site was 0.59-2.79 (median: 1.61). Sixty patients had flaps greater than the resection area, whereas 6 had smaller flaps. Significant differences were found in speech intelligibility and swallowing function when the reconstructed dimension ratio was categorized as follows: ≤1.3, 1.3-1.8, and ≥1.8.

CONCLUSION

Our findings suggest that postoperative deterioration of oral functions after hemiglossectomy could be reduced if reconstruction is performed using a forearm free flap with a surface area 1.3 to 1.8 times greater than that of the resection area.

Functional results of microvascular reconstruction after hemiglossectomy: free anterolateral thigh flap versus free forearm flap

The aim of the present study is to assess functional outcomes after hemiglossectomy and microvascular reconstruction. Twenty-six patients underwent primary tongue microvascular reconstruction after hemiglossectomy. Twelve patients were reconstructed using a free radial forearm flap and 14 with an anterolateral thigh flap. Speech intelligibility, swallowing capacity and quality of life scores were assessed. Factors such as tumour extension, surgical resection and adjuvant radiotherapy appeared to be fundamental to predict post-treatment functional outcomes. The data obtained in the present study indicate that swallowing capacity after hemiglossectomy is better when an anterolateral thigh flap is used. No significant differences were seen for speech intelligibility or quality of life between free radial forearm flap and anterolateral thigh flap.

Squamous cell carcinoma of tongue in a renal transplant recipient

The overall incidence of malignancies in post renal transplant recipients is reported to be approximately 5 to 6%. Malignancies are significant complications after transplantation. Common malignancies include malignancies of the skin and post-transplant lymphoproliferative disorder (PTLD). Squamous cell carcinoma of the tongue is very rare. We present a case of squamous cell carcinoma of the tongue developing nine years after renal transplantation, in a 30-year-old man. He underwent left hemiglossectomy initially and then modified neck dissection. His graft function continues to remain stable.

Wide excision versus hemiglossectomy

Cancer of the oral tongue is a common disease. Thirty five (35%) percent of patients seen at our hospital are in Stages I&II. The choice of surgical treatment is a wide excision of the lesion (WE) or a hemiglossectomy (HG). This study was carried out to compare the local recu-rrences and survival in patients undergoing either a WE or HG for early cancer of the tongue. One hundred and twenty six (126) patients were evaluated, 40 underwent a WE and 86 HG. The local recurrence was higher in the WE group, 25% compared with 9% in the HG group; which is statistically significant (p=0.02). This was also seen in the Tl subgroup (p=0.003). Survival were better in the HG group (p=0.005), which was also seen for the Tl subgroup (p=0.004). Our study demonstrates that there is a lower incidence of local recurrences following a hemiglossectomy for Tl-2 tumours of the oral tongue with improved survivals. Our recommendation is that hemi-glossectomy should be the optimal surgery performed for early cancer of the oral tongue.