Analysis of the Relations Between the Shape of the Reconstructed Tongue and Postoperative Functions After Subtotal or Total Glossectomy

Authors

  • Yoshihiro Kimata MD,

    Corresponding author
    1. Division of Plastic and Reconstructive Surgery and Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
    • Yoshihiro Kimata, MD, Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277, Japan.
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  • Minoru Sakuraba MD,

    1. Division of Plastic and Reconstructive Surgery and Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
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  • Shigeyuki Hishinuma MD,

    1. Division of Plastic and Reconstructive Surgery and Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
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  • Satoshi Ebihara MD,

    1. Division of Plastic and Reconstructive Surgery and Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
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  • Ryuichi Hayashi MD,

    1. Division of Plastic and Reconstructive Surgery and Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
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  • Takahiro Asakage MD,

    1. Division of Plastic and Reconstructive Surgery and Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
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  • Takashi Nakatsuka MD,

    1. Department of Plastic and Reconstructive Surgery, Saitama Medical School, Saitama, Japan
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  • Kiyonori Harii MD

    1. Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
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  • Supported by a Grant-in-Aid for Cancer Research 9-17 from the Ministry of Health and Welfare of Japan.

    Presented in part at the 24th Annual Meeting of the Japan Society for Head and Neck Cancer, June 14, 2000, Tokyo, Japan.

Abstract

Objectives/Hypothesis For reconstruction after subtotal or total glossectomy, both preserving the larynx and maintaining postoperative swallowing and speech functions can greatly improve quality of life; however, postoperative functional results are often unstable. Our experiences suggest that insufficient flap volume in the oral area and postoperative prolapse of the preserved larynx affect postoperative function. The objective was to investigate the relations of the shape of the reconstructed tongue to postoperative swallowing and speech functions.

Study Design The shape of the reconstructed tongue was classified on the basis of magnetic resonance and intraoral inspection as protuberant, semi-protuberant, flat, or depressed. Speech intelligibility was evaluated, and body weight, which might affect the shape of the transferred flap, was measured before and after surgery.

Methods Thirty patients who had undergone subtotal or total glossectomy and subsequent reconstruction were reviewed.

Results We found that speech intelligibility (P <.001), food (P <.01), and deglutition (P <.003) scores were significantly lower in patients with flat or depressed tongues than in patients with semi-protuberant or protuberant tongues. Weight loss after surgery was significantly greater in patients with depressed tongues than in other patients (P <.013). Our results indicate that postoperative function is related to the shape of the reconstructed tongue.

Conclusions We suggest that 1) wider and thicker flaps, such as rectus abdominis musculocutaneous flaps, be used; 2) flaps be designed to be approximately 30% wider than the defect; 3) laryngeal suspension be used to prevent prolapse of the transferred flap; and 4) careful general management and sufficient nutrition are important in the early postoperative period.

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