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Effect of lingual and hypoglossal nerve reconstruction on swallowing function in head and neck surgery: prospective
Daniel A O'Connell1, Jana Reiger, Peter T Dziegielewski
1Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta.
Objectives:
To examine the effect on oral swallowing function of reanastomosis of lingual and hypoglossal nerves divided and reconstructed during head and neck cancer surgery and to determine the importance (if any) of sensory reconstruction in oral cavity cancer surgery.
Study Design:
Prospective cohort study.
Methods:
Forty-four patients underwent resection and free tissue reconstruction of oropharyngeal squamous cell carcinoma between January 1999 and September 2006. Postoperative lingual and hypoglossal nerve status was recorded. All patients were scheduled to undergo videofluoroscopic swallowing studies (VFSSs) pre- and 12 months postoperatively. The oral residue score, bolus oral transit time, and aspiration score were recorded for all patients completing the assessments.
Results:
The oral transit time and oral residue score increased in patients with both lingual and hypoglossal nerves resected. Oral swallowing efficiency was preserved if one or both of the lingual and hypoglossal nerves were preserved or reconstructed following cancer resection. Ninety-one percent of patients swallowed safely at 12 months postoperatively.
Conclusions:
Loss of both the lingual (sensory) and hypoglossal (motor) supply of parts of the oral cavity has a detrimental effect on oral swallowing. If either the sensory or the motor supply to these regions can be preserved or reconstructed, oral swallowing efficiency can be maintained. During oral cancer extirpation, removal of muscular structures often negates possible motor reconstruction. This increases the need for sensate reconstruction of oral cavity defects via primary reanastomosis of nerves or sensate free tissue transfer to preserve oral swallowing efficiency.
