Videofluoroscopic Study of Swallowing Function in Hemiglossectomized Patients-Comparison of Primary Closure and Free Radial Forearm Flap Reconstruction

Abstract

The swallowing function of patients who had undergone hemiglossectomy with either primary closure of the defect or radial forearm flap reconstruction were studied with videofluoroscopy. Patients with primary closure were unable to lift the tongue tip, had poor tongue-to-palate contact on initiating swallowing, premature spilling of the bolus into the pharynx, a large amount of barium stasis on the floor of the mouth, and prolonged oral transit time. With flap reconstruction, patients could easily lift the tongue and make good contact with the entire palate. They were able to seal the posterior pharyngeal sphincter by elevation of the reconstructed tongue, approximating it to the soft palate, so that premature spilling of the bolus rarely happened. Their swallowing pattern was nearly normal. Although the reconstructed flap is nonfunctional, it provides bulk and helps the remaining tongue to complete the swallow. Compared with primary closure of the tongue defect, free radial forearm flap reconstruction provides better swallowing function when more than 50% of the tongue is resected.