Derrick T Lin1, Bharat B Yarlagadda1, Rosh K V Sethi2, Allen L Feng3, Yelizaveta Shnayder4, Levi G Ledgerwood4, Jason A Diaz5, Parul Sinha5, Matthew M Hanasono6, Peirong Yu6, Roman J Skoracki6, Timothy S Lian7, Urjeet A Patel8, Jason Leibowitz9, Nicholas Purdy9, Heather Starmer3, Jeremy D Richmon3. 1. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston. 2. Harvard Medical School, Boston, Massachusetts. 3. Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland. 4. Department of Otolaryngology-Head and Neck Surgery, Kansas University Medical Center, Kansas City. 5. Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri. 6. Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston. 7. Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans. 8. Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois. 9. Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida.
Abstract
IMPORTANCE: The optimal reconstruction of total glossectomy defects with or without total laryngectomy is controversial. Various pedicled and free tissue flaps have been advocated, but long-term data on functional outcomes are not available to date. OBJECTIVES: To compare various total glossectomy defect reconstructive techniques used by multiple institutions and to identify factors that may lead to improved long-term speech and swallowing function. DESIGN, SETTING, AND PARTICIPANTS: A multi-institutional, retrospective review of electronic medical records of patients undergoing total glossectomy at 8 participating institutions between June 1, 2001, and June 30, 2011, who had a minimal survival of 2 years. INTERVENTION: Total glossectomy with or without total laryngectomy. MAIN OUTCOMES AND MEASURES: Demographic and surgical factors were compiled and correlated with speech and swallowing outcomes. RESULTS: At the time of the last follow-up, 45% (25 of 55) of patients did not have a gastrostomy tube, and 76% (42 of 55) retained the ability to verbally communicate. Overall, 75% (41 of 55) of patients were tolerating at least minimal nutritional oral intake. Feeding tube dependence was not associated with laryngeal preservation or the reconstructive techniques used, including flap suspension, flap innervation, or type of flap used. Laryngeal preservation was associated with favorable speech outcomes, such as the retained ability to verbally communicate in 97% of those not undergoing total laryngectomy (35 of 36 patients) vs 44% (7 of 16) in those undergoing total laryngectomy (P < .001), as well as those not undergoing total laryngectomy achieving some or all intelligible speech in 85% (29 of 34 patients) compared with 31% (4 of 13) undergoing total laryngectomy achieving the same intelligibility (P < .001). CONCLUSIONS AND RELEVANCE: In patients with total glossectomy, feeding tube dependence was not associated with laryngeal preservation or the reconstructive technique, including flap innervation and type of flap used. Laryngeal preservation was associated with favorable speech outcomes such as the retained ability to verbally communicate and higher levels of speech intelligibility.
IMPORTANCE: The optimal reconstruction of total glossectomy defects with or without total laryngectomy is controversial. Various pedicled and free tissue flaps have been advocated, but long-term data on functional outcomes are not available to date. OBJECTIVES: To compare various total glossectomy defect reconstructive techniques used by multiple institutions and to identify factors that may lead to improved long-term speech and swallowing function. DESIGN, SETTING, AND PARTICIPANTS: A multi-institutional, retrospective review of electronic medical records of patients undergoing total glossectomy at 8 participating institutions between June 1, 2001, and June 30, 2011, who had a minimal survival of 2 years. INTERVENTION: Total glossectomy with or without total laryngectomy. MAIN OUTCOMES AND MEASURES: Demographic and surgical factors were compiled and correlated with speech and swallowing outcomes. RESULTS: At the time of the last follow-up, 45% (25 of 55) of patients did not have a gastrostomy tube, and 76% (42 of 55) retained the ability to verbally communicate. Overall, 75% (41 of 55) of patients were tolerating at least minimal nutritional oral intake. Feeding tube dependence was not associated with laryngeal preservation or the reconstructive techniques used, including flap suspension, flap innervation, or type of flap used. Laryngeal preservation was associated with favorable speech outcomes, such as the retained ability to verbally communicate in 97% of those not undergoing total laryngectomy (35 of 36 patients) vs 44% (7 of 16) in those undergoing total laryngectomy (P < .001), as well as those not undergoing total laryngectomy achieving some or all intelligible speech in 85% (29 of 34 patients) compared with 31% (4 of 13) undergoing total laryngectomy achieving the same intelligibility (P < .001). CONCLUSIONS AND RELEVANCE: In patients with total glossectomy, feeding tube dependence was not associated with laryngeal preservation or the reconstructive technique, including flap innervation and type of flap used. Laryngeal preservation was associated with favorable speech outcomes such as the retained ability to verbally communicate and higher levels of speech intelligibility.
Authors: Diane W Chen; Tao Wang; Jonathan Shey-Sen Ni; Vlad C Sandulache; Evan M Graboyes; Mitchell Worley; Joshua D Hornig; Judith M Skoner; Terry A Day; Andrew T Huang Journal: Oral Oncol Date: 2019-03-28 Impact factor: 5.337
Authors: Harri Keski-Säntti; Leif Bäck; Patrik Lassus; Petri Koivunen; Ilpo Kinnunen; Henry Blomster; Antti A Mäkitie; Katri Aro Journal: Eur Arch Otorhinolaryngol Date: 2017-11-08 Impact factor: 2.503
Authors: Sagar Kansara; Tao Wang; Sina Koochakzadeh; Nelson E Liou; Evan M Graboyes; Judith M Skoner; Joshua D Hornig; Vlad C Sandulache; Terry A Day; Andrew T Huang Journal: Oral Oncol Date: 2019-09-12 Impact factor: 5.337