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Swallowing and Speaking Evaluation After Resection and Reconstruction Versus Definite Radiochemotherapy for
Tobias Ettl1, Johannes K Meier1, Peter Kummer2
1From the Department of Oral and Maxillofacial Surgery, Regensburg University Hospital, Regensburg, Germany.
Plastic and Reconstructive Surgery. Global Open
|March 17, 2025
Summary
For advanced tongue cancer, glossectomy with reconstruction offers comparable or better swallowing function than radiochemotherapy alone. Survival rates were similar between the two treatment groups.
Area of Science:
- Oncology
- Head and Neck Surgery
- Radiotherapy
Background:
- Definitive radiochemotherapy (RCHT) is often favored for advanced tongue cancer to preserve organs and function, especially swallowing.
- However, surgical options like glossectomy with reconstruction are also considered.
Purpose of the Study:
- To compare the functional outcomes and survival rates of patients with advanced tongue cancer treated with glossectomy and RCHT versus definitive RCHT.
- To evaluate swallowing efficiency and airway protection in these patient groups.
Main Methods:
- A retrospective study of 10 patients with advanced tongue cancer who underwent (sub)total glossectomy with prior or adjuvant RCHT and anterolateral thigh flap reconstruction.
- Comparison with 10 patients treated with definitive RCHT.
- Swallowing function assessed using fiberoptic endoscopic evaluation of swallowing (FEES) with the Penetration and Aspiration Scale (PAS) and Yale Pharyngeal Residue Severity Rating Scale (YPRS).
Main Results:
- 70% of surgical patients achieved full oralization within a mean of 17 days.
- Surgical patients demonstrated significantly lower PAS and YPRS scores for saliva, indicating better swallowing efficiency compared to the definitive RCHT group.
- Age over 65, BMI under 20 kg/m², and Karnofsky index below 80 were associated with poorer swallowing outcomes.
- Speech intelligibility was 80% in both groups, and overall survival rates were comparable.
Conclusions:
- Glossectomy with anterolateral thigh flap reconstruction provides equal or superior swallowing function compared to definitive RCHT for advanced tongue cancer.
- This surgical approach, combined with RCHT, offers a viable alternative for organ preservation and functional recovery.
