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Free forearm flap in oral reconstruction. Functional outcome
M C Jacobson1, E Franssen, D M Fliss
1Speech Pathology Service, Sunnybrook Health Science Centre, North York, Ontario.
Objective:
To examine functional outcome associated with free radical forearm flap reconstruction of oral cavity and oropharyngeal defects.
Design And Setting:
Case series obtained from a head and neck clinic conducted at a regional cancer center. Patients underwent surgery at the associated tertiary care center.
Patients:
Thirty consecutive patients treated for oral and oropharyngeal malignant neoplasms staged from T1 to T4 were studied. Subjects were assigned to five groups based on the site and extent of their surgical resections, as specified on a resection template.
Intervention:
All patients had undergone free radial forearm flap reconstruction of their surgical defects.
Outcome Measures:
Ten factors reflecting functional properties and processes of the upper aerodigestive tract were evaluated clinically or with videofluoroscopy or both.
Results:
Near-normal and fair oral and oropharyngeal function wholly characterized the sample. Patients who underwent reconstruction of unilateral tongue, floor of mouth-ventral tongue, and retromolar trigone-buccal defects functioned well on most measures; the function of patients with anterior tongue-jaw and tongue base-tonsil defects varied.
Conclusions:
Functional outcome with free radial forearm flap reconstruction was favorable for three of five subgroups of oral and oropharyngeal cancer patients. Qualitatively different functional profiles emerged for subgroups based on resection site. Methodologic issues for research on surgical reconstruction and functional outcome include the need for a meaningful, reliable system of classifying oral and oropharyngeal resections, and the development of standardized procedures for evaluating functional outcome.