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Quality of life after free-flap tongue reconstruction

Published online by Cambridge University Press:  17 September 2008

D M Hartl*
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France
S Dauchy
Affiliation:
Department of Oncopsychiatry, Institut Gustave Roussy, Villejuif, France
C Escande
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France
E Bretagne
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France
F Janot
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France
F Kolb
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France
*
Address for correspondence: Dr Dana M Hartl, Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France. Fax: +33 1 42 11 52 73 E-mail: dana.hartl@igr.fr

Abstract

Objective:

To analyse correlations between quality of life measures, aspiration and extent of surgical resection in patients who have undergone free-flap tongue reconstruction.

Patients and methods:

Nine consecutive patients (seven men and two women; average age 51 years) who had been diagnosed with T4a carcinoma of the mobile tongue and/or tongue base and treated by glossectomy, free-flap reconstruction, and either radiation therapy or chemoradiation responded to the European Organization for Research and Treatment of Cancer Head and Neck-35 questionnaire, the performance status scale questionnaire and the hospital anxiety–depression scale questionnaire, an average of 43 months after treatment (range 18–83 months). Aspiration was evaluated by fibre-optic laryngoscopy. Correlations between quality of life domain scores, extent of surgery and the presence of aspiration were evaluated using non-parametric statistical analysis.

Results:

Scores for the swallowing and aspiration domains of the European Organization for Research and Treatment of Cancer Head and Neck-35 questionnaire were significantly correlated with the extent of tongue base resection (Spearman's correlation, p = 0.037 and 0.042, respectively). Despite a strong correlation between the European Organization for Research and Treatment of Cancer Head and Neck-35 questionnaire results and the performance status scale global scores (correlation coefficient = 0.89, p = 0.048), the performance status scale domain scores were not correlated with the extent of tongue resection. Clinically apparent aspiration was not correlated with the extent of tongue resection, nor were the anxiety or depression scores. However, clinically apparent aspiration was significantly related to the swallowing and aspiration domain scores of the European Organization for Research and Treatment of Cancer Head and Neck-35 questionnaire (p = 0.017 in both cases).

Conclusions:

Our results imply that the volume of tongue base resection is a major factor in swallowing- and aspiration-related quality of life following tongue resection and free-flap reconstruction. Free-flap reconstruction does not seem to palliate the effect of the loss of functional tongue base volume, as regards swallowing-related quality of life.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2008

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References

1 Logemann, JA. Upper digestive tract anatomy and physiology. In: Bailey, BJ, ed. Head and Neck Surgery-Otolaryngology. Philadelphia: Lipincott, 1993;485–91Google Scholar
2 Hamlet, S, Jones, L, Patterson, R, Michou, G, Cislo, C. Swallowing recovery following anterior tongue and floor of mouth surgery. Head Neck 1991;13:334–9Google Scholar
3 McConnel, FMS, Pauloski, PR, Logemann, JA, Rademaker, AW, Colangelo, L, Shedd, D et al. Functional results of primary closure versus flaps in oropharyngeal reconstruction. Arch Otolaryngol Head Neck Surg 1998;124:625–30Google Scholar
4 Urken, ML, Moscoso, JF, Lawson, W, Biller, HF. A systematic approach to functional reconstruction of the oral cavity following partial and total glossectomy. Arch Otolaryngol Head Neck Surg 1994;120:589601Google Scholar
5 Salibian, AH, Allison, GR, Armstrong, WB, Krugman, ME, Strelzow, VV, Kelly, T et al. Functional hemitongue reconstruction with the microvascular ulnar forearm flap. Plast Reconstr Surg 1999;104:654–60CrossRefGoogle ScholarPubMed
6 Urken, ML, Buchbinder, D, Weinberg, H, Vickery, C, Sheiner, A, Parker, R et al. Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: a comparative study of reconstructed and nonreconstructed patients. Laryngoscope 1991;101:935–50CrossRefGoogle Scholar
7 Kiyokawa, K, Tai, Y, Inoue, Y, Yanagara, H, Mori, K, Nakashima, T. Functional reconstruction of swallowing and articulation after total glossectomy without laryngectomy: money pouch-like reconstruction method using rectus abdominis myocutaneous flaps. Plast Reconstr Surg 1999;104:2015–20CrossRefGoogle Scholar
8 Yamamoto, Y, Sugihara, T, Furuta, Y, Fukuda, S. Functional reconstruction of tongue and deglutition muscles following extensive resection of tongue cancer. Plast Reconstr Surg 1998;102:993–8CrossRefGoogle ScholarPubMed
9 Curtis, DA, Plesh, O, Miller, AJ, Curtis, TA, Sharma, A, Schweitzer, R et al. A comparison of masticatory function in patients with or without reconstruction of the mandible. Head Neck 1997;19:287–96Google Scholar
10 Salibian, AH, Allison, GR, Strezow, VV, Krugman, ME, Rappaport, I, McMicken, BL et al. Secondary microvascular tongue reconstruction: functional results. Head Neck 1993;15:389–97CrossRefGoogle ScholarPubMed
11 Sobin, LH, Wittekind, C, eds. UICC International Union Against Cancer. TNM Classification of Malignant Tumors, 6th edn. New York: Wiley-Liss, 2002;1942Google Scholar
12 Aaronson, NK, Ahmedzai, S, Bergman, B, Bullinger, M, Cull, A, Duez, NJ et al. The European Organization for Research and Treatment of Cancer Head and Neck-35: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993;85:365–76Google Scholar
13 D'Antonio, LL, Zimmerman, GJ, Cella, DF, Long, SA. Quality of life and functional status measures in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 1996;122:482–7CrossRefGoogle ScholarPubMed
14 Freidman, S, Samuelian, JC, Lancrenon, S, Even, C, Chiarelli, P. Three-dimensional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression. Psychiatry Res 2001;104:247–57Google Scholar
15 Bastian, RW. Videoendoscopic evaluation of patients with dysphagia: an adjunct to the modified barium swallow. Otolaryngol Head Neck Surg 1991;104:339–50Google Scholar
16 McConnel, FMS, Logemann, JA, Rademaker, AW, Pauloski, BR, Baker, SR, Lewin, J et al. Surgical variables affecting postoperative swallowing efficiency in oral cancer patients: a pilot study. Laryngoscope 1994;104:8790CrossRefGoogle ScholarPubMed
17 Colangelo, LA, Logemann, JA, Pauloski, BR, Pelzer, HJ, Rademaker, AW. T Stage and functional outcome in oral and oropharyngeal cancer patients. Head Neck 1996;18:259–683.0.CO;2-Z>CrossRefGoogle ScholarPubMed
18 Kotz, T, Costello, R, Li, Y, Posner, MR. Swallowing dysfunction after chemoradiation for advanced squamous cell carcinoma of the head and neck. Head Neck 2004;26:365–72CrossRefGoogle ScholarPubMed
19 Rademaker, AW, Vonesh, EF, Logemann, JA, Pauloski, BR, Liu, D, Lazarus, CL et al. Eating ability in head and neck cancer patients after treatment with chemoradiation: a 12-month follow-up study accounting for dropout. Head Neck 2003;25:1034–41Google Scholar
20 Wagner, JD, Coleman, JJ 3rd, Weisberger, E, Righi, PD, Radpour, S, McGarvey, S et al. Predictive factors for functional recovery after free tissue transfer oromandibular reconstruction. Am J Surg 1998;176:430–5Google Scholar
21 Ruhl, CM, Gleich, LL, Gluckman, JL. Survival function and quality of life after total glossectomy. Laryngoscope 1997;107:1316–21CrossRefGoogle ScholarPubMed