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Gregory Lvoff, MDS, MBBS; Christopher J. O'Brien, MS, FRACS; Charles Cope, MBBS; Kenneth K. Lee, FRACS

Arch Otolaryngol Head Neck Surg. 1998;124:1206-1208.

Background  Reinnerveration of free flaps used in oral and oropharyngeal reconstruction may provide a high level of sensory return. Spontaneous recovery of sensation in noninnervated flaps may also occur.

Objective  To evaluate the extent of spontaneous sensory return among patients who underwent radial forearm free flap reconstruction in the oral cavity and oropharynx.

Methods  A total of 40 patients were evaluated by 2 independent examiners. The median patient age was 60 years, and the median time from surgery was 47 months. A total of 29 patients had received postoperative radiotherapy. The mean flap size was 25 cm². The following sensory modalities were tested: light touch, pinprick, hot and cold, and moving and static 2-point discrimination.

Results  Recovery of sensation of at least 1 modality was noted in 32 patients (80%), however, only 5 patients (13%) had return of all 5 modalities. Eight patients (20%) had no sensory return. There was a trend to improved sensory recovery in flaps placed in the alveolar and retromolar trigone areas; however, on multivariate analysis, sensory return could not be predicted by any of the following factors: patient age, flap site, flap size, length of follow-up, and use of postoperative radiotherapy.

Conclusions  Complete sensory recovery was uncommon, unpredictable, and variable, although some recovery of sensation occurred in 80% of patients. It is not valid to rely on spontaneous sensory recovery for sensory innervation of free flaps. Correlation of sensory return with function is still needed.

From the Departments of Head and Neck Surgery (Drs Lvoff and O'Brien) and Plastic and Reconstructive Surgery (Drs Cope and Lee), Royal Prince Alfred Hospital, Sydney, Australia.

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