Intermediate Volume Glossectomy Defects Reconstruction: Flap Versus Primary Closure

To compare quality-of-life (QoL) outcomes between flap reconstruction and primary closure following intermediate-volume (partial to hemi-) glossectomy in patients with oral tongue carcinoma.

Retro-prospective cross-sectional study.

Department of Otolaryngology-Head and Neck Surgery, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

Seventy patients undergoing partial to hemi-glossectomy were included and grouped by reconstruction method (flap reconstruction vs primary closure). QoL was assessed at 6 to 12 months posttreatment using the EORTC QLQ-H&N35 questionnaire. Multivariable linear regression was performed adjusting for age, stage group, neck dissection, and adjuvant therapy. Effect sizes were calculated to evaluate clinical relevance.

Baseline demographic and clinicopathologic characteristics were comparable between groups. Operative time was significantly longer in the flap group. Flap reconstruction was associated with significantly better QoL, including lower overall HN35 scores (40.89 ± 3.39 vs 44.74 ± 5.26; P < .01), and improved swallowing and speech domains (both P < .01). In multivariable analysis, flap reconstruction remained independently associated with better overall QoL (adjusted β, -5.23; 95% CI, -7.09 to -3.37; P < .001), swallowing (adjusted β, -2.18; P < .001), and speech (adjusted β, -1.65; P < .001). Effect size analysis demonstrated large to very large effects. Wound complications were more frequent in the flap group (14.3% vs 0%; P = .02).

Flap reconstruction was associated with improved QoL at 6 to 12 months, particularly in swallowing and speech, but with longer operative time and higher wound complication rates. Prospective studies are warranted to confirm these findings.