Abstract
To assess functional outcomes in patients treated by compartmental tongue surgery (CTS) and reconstruction for advanced oral tongue/floor-of-mouth cancer. Retrospective case series. A retrospective cohort of patients (n = 48) treated by CTS and free flap reconstruction was prospectively evaluated concerning postoperative functional outcomes at different time points (6 months and 1 year). Swallowing was studied by videonasal endoscopic evaluation (VEES) and videofluoroscopy (VFS), testing various food consistencies and grading the results with the Donzelli scale. Speech articulation, lingual strength, and endurance were studied by phone call and Iowa Oral Performance Instrument (IOPI). Subjective tests (EORTC H&N35 and UWQOL) were administered. After 1 year, VEES showed a Donzelli scale of 67% level 1, 23% level 2, and 10% level 3. Vallecular pouch was present in 81% of patients. VFS showed levels 1, 2, and 3 in 42%, 25%, and 33%, respectively, with liquids (L); 48%, 19%, and 33%, with semi-liquids (SL); and 54%, 33%, and 13%, with semi-solids (SS). Vallecular pouch residue was present in 69% with L, 73% with SL, and 87% with SS. The mean number of words recognized at phone call was 56 of 75 (range, 27-74). IOPI showed a mean tongue strength of 19.2 kPa (range, 0-40), and a mean endurance of 16.2 seconds (range, 0-60). CTS does not significantly affect speech. Sub-clinical food aspiration and vallecular pouch are present in a significant proportion of patients, especially when adjuvant treatments are administered. Residual tongue strength is not affected when proper reconstruction is performed. 4 Laryngoscope, 131:E176-E183, 2021.
Highlights
Treatment strategies for oral tongue/floor-of-mouth squamous cell carcinoma (OTFOMSCC) have not substantially changed in the last decades and consist, for advanced lesions, in surgery followed by adjuvant radiotherapy (RT) or chemoradiotherapy (CRT)
The authors declare that this manuscript was conceived and written by the cited authors, they do not have to disclose financial information, and they confirm no conflict of interest concerning this manuscript
This study was conducted in a tertiary academic referral hospital (Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Italy) from March 2008 to October 2017 on 48 patients consecutively treated with compartmental tongue surgery (CTS) followed by fasciocutaneous free flap reconstruction for naive OTFOMSCC with a depth of infiltration (DOI) > 10 mm (Table I)
Summary
Treatment strategies for oral tongue/floor-of-mouth squamous cell carcinoma (OTFOMSCC) have not substantially changed in the last decades and consist, for advanced lesions, in surgery followed by adjuvant radiotherapy (RT) or chemoradiotherapy (CRT). Conventional oral surgery with macroscopic healthy margins of 1–2 cm has not been universally accepted as a proper technique to optimize local control and may present issues in terms of consistency and reproducibility. From the Department of Otorhinolaryngology – Head and Neck Surgery (A.G., N.M., F.D.B., A.P., D.L., M.F., A.D., D.L., P.N.), University of Brescia, Brescia, Italy; Department of Otorhinolaryngology (C.P.), Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, Milan, Italy; Department of Oncology and Oncohaematology (C.P.), University of Milan, Milan, Italy; Department of Radiology (B.F.), University of Brescia, Brescia, Italy; and the Department of Physical Medicine and Rehabilitation (M.M.), University of Brescia, Brescia, Italy. Editor’s Note: This Manuscript was accepted for publication on February 28, 2020.
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