Functional Outcomes After Primary Oropharyngeal Cancer Resection and Reconstruction With the Radial Forearm Free Flap

Authors

  • Hadi Seikaly MD, FRCSC,

    Corresponding author
    1. Craniofacial Osseointegration and Maxillofacial Prosthetic Rehabilitation Unit, University of Alberta, Alberta, Canada.
    2. Division of Otolaryngology—Head and Neck Surgery, University of Alberta, Alberta, Canada.
    3. Division of Faculties of Medicine and Dentistry, University of Alberta, Alberta, Canada.
    4. Cross Cancer Institute, Edmonton, Alberta, Canada.
    • Hadi Seikaly, MD, FRCSC, Garneau Professional Center, 401, 11044-82 Avenue, Edmonton, Alberta, Canada.
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  • Jana Rieger PhD,

    1. Craniofacial Osseointegration and Maxillofacial Prosthetic Rehabilitation Unit, University of Alberta, Alberta, Canada.
    2. Division of Rehabilitation Medicine, University of Alberta, Alberta, Canada.
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  • John Wolfaardt BDS, MDent, PhD,

    1. Craniofacial Osseointegration and Maxillofacial Prosthetic Rehabilitation Unit, University of Alberta, Alberta, Canada.
    2. Division of Faculties of Medicine and Dentistry, University of Alberta, Alberta, Canada.
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  • Gerald Moysa MD, FRCSC,

    1. Division of Plastic Surgery, University of Alberta, Alberta, Canada.
    2. Division of Faculties of Medicine and Dentistry, University of Alberta, Alberta, Canada.
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  • Jeffery Harris MD, FRCSC,

    1. Division of Otolaryngology—Head and Neck Surgery, University of Alberta, Alberta, Canada.
    2. Division of Faculties of Medicine and Dentistry, University of Alberta, Alberta, Canada.
    3. Cross Cancer Institute, Edmonton, Alberta, Canada.
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  • Naresh Jha MBBS

    1. Craniofacial Osseointegration and Maxillofacial Prosthetic Rehabilitation Unit, University of Alberta, Alberta, Canada.
    2. Cross Cancer Institute, Edmonton, Alberta, Canada.
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  • Supported by the Minerva Foundation of Edmonton.

Abstract

Objective To report prospectively collected aeromechanical, acoustical, and perceptual speech outcomes, as well as preliminary swallowing data, in patients having reconstruction with radial forearm free flaps after primary resection for oropharyngeal cancer.

Study Design Prospective cohort study.

Methods Acoustical, aeromechanical, and perceptual speech data and swallowing data were gathered at three evaluation times (preoperatively and before and after radiation therapy) for patients treated for oropharyngeal cancer by means of primary resection and reconstruction with a radial forearm free flap. Degree of involvement of the soft palate and base of tongue, along with reconstructive techniques, were entered as between-group factors in the analysis.

Results There were no significant differences in speech intelligibility between the patient groups based on the degree of palate and tongue resected. However, patients with resections of half or more than half of the soft palate had significantly higher nasalance values and larger velopharyngeal orifice areas than individuals who had less than half of the soft palate resected. Significant within-subject differences were revealed across evaluation times for the dependent variables nasalance, velopharyngeal orifice area, and word intelligibility. Ninety-four percent of the patients were able to resume a normal or soft diet. There was a 6% incidence of aspiration in 128 swallows that were analyzed. The amount of base of tongue resected did not significantly affect any of the speech or swallowing parameters.

Conclusions Radial forearm free flaps are a good reconstructive option after oropharyngeal cancer extirpation. Our acoustic and aeromechanical results indicated that issues related to quality of the speech signal require further study for resections of half or more than half of the soft palate.

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