Rieger Jana M, Zalmanowitz Jana G, Li Shirley Y Y, Sytsanko Anna, Harris Jeffrey, Williams David, Seikaly Hadi
Craniofacial Osseointegration and Maxillofacial Prosthetic Rehabilitation Unit, Misericordia Hospital, Caritas Health Group, Edmonton, Alberta, Canada.
Head Neck. 2007 Nov;29(11):1024-32. doi: 10.1002/hed.20623.
Historically, the prevention of functional morbidity after multimodal treatment for squamous cell carcinoma in patients with large base of tongue lesions has been challenging. The purpose of the present research is to report prospectively collected speech and swallowing outcomes for patients with disease that encompassed half or more of the base of tongue.
Speech and swallowing data were gathered at 4 evaluation times that spanned the first year of treatment for 32 patients treated with surgery and adjuvant radiation therapy.
Speech intelligibility remained above 90% for most patients. In the early postoperative period, patients with 100% of their base of tongue resected experienced decreased intelligibility, which improved by the half-way mark of the evaluations. The majority of patients resumed normal oral feeding, with those who lacked dentition needing to puree their food. Modified barium swallow studies revealed that only 3 patients aspirated thin liquid at the final evaluation. Five patients used a feeding tube at some point over the year of evaluation. At the final evaluation, only 3 patients required enteral feeding, with 2 of these using the tube in combination with oral feeding and 1 using the tube for primary nutrition.
The results of this study suggest that surgical reconstruction of the base of tongue using the radial forearm free flap in patients with large base of tongue lesions can lead to functional speech and swallowing results.
从历史上看，对于舌根部病变较大的患者，多模式治疗后预防功能障碍一直具有挑战性。本研究的目的是前瞻性报告病变累及舌根部一半或更多的患者的言语和吞咽结果。
收集了32例接受手术和辅助放疗的患者在治疗第一年的4个评估时间点的言语和吞咽数据。
大多数患者的言语清晰度保持在90%以上。在术后早期，舌根部100%被切除的患者言语清晰度下降，但在评估中期有所改善。大多数患者恢复了正常经口进食，无牙患者需要将食物打成泥状。改良钡剂吞咽研究显示，在最终评估时只有3例患者吞咽稀液体时出现误吸。在评估的一年中，有5例患者在某个时间点使用了鼻饲管。在最终评估时，只有3例患者需要肠内营养，其中2例患者将鼻饲管与经口进食联合使用，1例患者将鼻饲管作为主要营养方式。
本研究结果表明，对于舌根部病变较大的患者，采用桡侧前臂游离皮瓣进行舌根部手术重建可取得较好的言语和吞咽功能结果。
