Sensation recovery on innervated radial forearm flap for hemiglossectomy reconstruction by using different recipient...

The objectives of this study were (1) to determine the extent of sensory recovery on hemitongues reconstructed with innervated radial forearm flaps and (2) to assess the influence of various clinical and surgical factors over the return of sensation, including the use of different recipient nerves for neurorrhaphy. Twenty-eight patients with tongue cancer who underwent hemiglossectomy and primary reconstruction with innervated radial forearm flaps over a 3-year period were studied. Mean postoperative follow-up was 18.2 months (range 6 to 32 months). Sensory recovery was assessed in a blind manner by two examiners that used (1) static two-point discrimination, (2) light touch sensation, (3) pain perception, and (4) hot and cold temperature perception. Different surfaces were assessed with each method on the reconstructed hemitongue and on the intact contralateral hemitongue (used as control). The following factors and their relationship with flap sensory recovery were analyzed: age, smoking history, size of the reconstructed defect, administration of postoperative radiation therapy, recipient nerve, and neurorrhaphy technique. Comparative statistical analysis (p < 0.05) between both hemitongues was performed using paired t test followed by Bonferroni correction for static two-point discrimination and light touch sensation. Fisher exact test analysis was used for pinprick and hot and cold temperature perception. The control side was ignored in analyzing the effects of the risk factors. The tip, dorsal aspect, ventral surface, and floor of mouth on the reconstructed hemitongue had comparable static two-point discrimination when compared with the intact hemitongue. Light touch sensation was also similar in the tip and dorsal aspect of both hemitongues; however, a statistically significant difference (p < 0.05) was observed on the ventral surface and floor of mouth of the reconstructed hemitongues. Likewise, pain perception was significantly decreased in the floor of the mouth, compared with other surfaces. No clearly dependent association was established between return of flap sensation and age, tobacco use, and size of the reconstructed defect. Light touch sensation, pain, and temperature perception were significantly decreased when the patients had received postoperative radiation therapy. In addition, all four sensory tests were significantly diminished (p < 0.05) when the recipient nerve used for neurorrhaphy was a nerve other than the lingual or the inferior alveolar nerve, and also when an end-to-side nerve repair was used. Sensation recovery of the innervated radial forearm flap after hemitongue reconstruction approaches normal compared with the contralateral intact hemitongue. Lower return of sensation may be anticipated in patients who receive postoperative radiotherapy. Good recovery of sensation is predictable when either the lingual or inferior alveolar nerve is used for neurorrhaphy, in contrast to using other recipient nerves.