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Swallowing Function in Patients With Base of Tongue Cancers Treated With Primary Surgery and Reconstructed With a Modified Radial Forearm Free Flap
Daniel Ambrose O’Connell, MD, MSc;
Jana Rieger, PhD;
Jeffrey Richard Harris, MD;
Peter Dziegielewski, BSc;
Jana Zalmanowitz, BSc;
Anna Sytsanko, MSc;
Shirley Li, PhD;
John Wolfaardt, BDS, MDent, PhD;
Robert D. Hart, MD;
Hadi Seikaly, MD
Arch Otolaryngol Head Neck Surg. 2008;134(8):857-864.
Objective To report swallowing outcomes and biomechanical properties of the base of the tongue (BOT) and the posterior pharyngeal wall (PPW) in patients who undergo surgical reconstruction with the beavertail modification of radial forearm free flap after primary resection of BOT cancer.
Design Prospective cohort study with a 1-year minimum follow-up performed between October 1, 2001, and August 31, 2005.
Setting Tertiary care facility.
Patients Patients diagnosed as having primary carcinoma of the BOT were treated with primary surgical resection and reconstruction followed by radiotherapy. Inclusion criteria were collection of videofluoroscopic swallowing study (VFSS) data before and 1 year after surgery. Forty-one patients were treated during a 5-year period, and 20 were included in the final analysis.
Interventions Reconstruction of BOT defects with the beavertail modification of radial forearm free flap followed by postoperative radiation.
Main Outcome Measures Aspiration score, pharyngeal residue score, and biomechanical analysis of BOT and PPW mobility were performed using images from VFSSs. Both the BOT and PPW positions were measured from 2 static bony landmarks.
Results Of the 20 patients in the final analysis, 19 (95%) were able to swallow safely at 1 year. Mobility of the BOT after surgery was reduced in all postoperative VFSS data. Anteroposterior dimension or bulk of the BOT was preserved. No significant difference was found in PPW mobility.
Conclusions The beavertail modification of the radial forearm free flap is a good reconstructive option after BOT cancer extirpation. The procedure preserves the bulk of the BOT after cancer treatment and maintains adequate BOT-PPW apposition. This allows structures such as the pharyngeal, oral, and suprahyoid musculature to contract and generate the necessary force to propel the food bolus through the oropharynx, resulting in a safe swallow.
Author Affiliations: Division of Otolaryngology–Head and Neck Surgery (Drs O’Connell, Harris, Hart, and Seikaly), Faculty of Rehabilitation Medicine (Dr Rieger), and Faculty of Medicine and Dentistry (Drs Harris, Wolfaardt, and Seikaly and Mr Dziegielewski), University of Alberta, and Craniofacial Osseointegration Maxillofacial Prosthetic Rehabilitation Unit, Misericordia Hospital (Drs Rieger, Li, Wolfaardt, and Seikaly and Mss Zalmanowitz and Sytsanko), Edmonton, Alberta, Canada.
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