Post-hemiglossectomy Reconstruction: Pilot Study on the Overall Functional Evaluation

The tongue plays a crucial role in speech, swallow and sleep. It is the most common site of primary intraoral cancer. A fasciocutaneous free flap is the first reconstructive option after surgery.

The aim of this study was to investigate the functional outcomes in patients treated with hemiglossectomy. We evaluated the objective tests and subjective assessments of swallowing, speech and sleep at 30 days after the surgery (T0) and at least 6 months after the end of the treatment (T1). We have implemented a battery of validated tools that comprehensively evaluate functional outcomes after resection of oral cancer, including speech, swallowing and head-and-neck-specific quality of life: MD Anderson Dysphagia Inventory (MDADI), Performance Status Scale-Head and Neck (PSS-HN) and Lazarus Tongue Range of Motion (ROM) Scale. Patients underwent objective tests such as videonasal endoscopic evaluation and magnetic resonance imaging. All patients were subjectively assessed with the Epworth Sleepiness Scale and underwent nocturnal polygraphy.

We treated six patients with advanced squamous cell carcinoma of the tongue; three received radial forearm flap and three received anterolateral thigh flap. Our study found that ROM, flap volume and defect volume are the most important characteristics for better MDADI, PSS-HN, Epworth score and respiratory disturbance index (RDI) on polygraphy.

Reconstruction of tongue cancer defects is challenging as the surgeon must consider adequate control of the tumour while also optimising residual functional capacity. The volume of the flap and ROM would seem to be the most important characteristics for improving the functional outcome.