O'Connell Daniel A, Reiger Jana, Dziegielewski Peter T, Tang Judith Lam, Wolfaardt Johan, Harris Jeffrey R, Mlynarek Alex, Seikaly Hadi
Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta.
J Otolaryngol Head Neck Surg. 2009 Apr;38(2):246-54.
To examine the effect on oral swallowing function of reanastomosis of lingual and hypoglossal nerves divided and reconstructed during head and neck cancer surgery and to determine the importance (if any) of sensory reconstruction in oral cavity cancer surgery.
Prospective cohort study.
Forty-four patients underwent resection and free tissue reconstruction of oropharyngeal squamous cell carcinoma between January 1999 and September 2006. Postoperative lingual and hypoglossal nerve status was recorded. All patients were scheduled to undergo videofluoroscopic swallowing studies (VFSSs) pre- and 12 months postoperatively. The oral residue score, bolus oral transit time, and aspiration score were recorded for all patients completing the assessments.
The oral transit time and oral residue score increased in patients with both lingual and hypoglossal nerves resected. Oral swallowing efficiency was preserved if one or both of the lingual and hypoglossal nerves were preserved or reconstructed following cancer resection. Ninety-one percent of patients swallowed safely at 12 months postoperatively.
Loss of both the lingual (sensory) and hypoglossal (motor) supply of parts of the oral cavity has a detrimental effect on oral swallowing. If either the sensory or the motor supply to these regions can be preserved or reconstructed, oral swallowing efficiency can be maintained. During oral cancer extirpation, removal of muscular structures often negates possible motor reconstruction. This increases the need for sensate reconstruction of oral cavity defects via primary reanastomosis of nerves or sensate free tissue transfer to preserve oral swallowing efficiency.
研究头颈部癌手术中切断并重建的舌神经和舌下神经再吻合对口腔吞咽功能的影响，并确定口腔癌手术中感觉重建的重要性（若有）。
前瞻性队列研究。
1999年1月至2006年9月期间，44例患者接受了口咽鳞状细胞癌的切除及游离组织重建手术。记录术后舌神经和舌下神经的状态。所有患者计划在术前和术后12个月接受视频荧光吞咽造影检查（VFSS）。记录所有完成评估的患者的口腔残留评分、食团口腔通过时间和误吸评分。
舌神经和舌下神经均被切除的患者，口腔通过时间和口腔残留评分增加。如果在癌症切除后保留或重建舌神经和舌下神经中的一条或两条，口腔吞咽效率得以保留。91%的患者在术后12个月时能够安全吞咽。
口腔部分区域舌神经（感觉）和舌下神经（运动）供应的丧失对口腔吞咽有不利影响。如果这些区域的感觉或运动供应能够保留或重建，口腔吞咽效率就能维持。在口腔癌切除术中，肌肉结构的切除往往使可能的运动重建无法实现。这就增加了通过神经一期再吻合或感觉游离组织移植对口腔缺损进行感觉重建以保留口腔吞咽效率的必要性。
