Yun In Sik, Lee Dong Won, Lee Won Jai, Lew Dae Hyun, Choi Eun Chang, Rah Dong Kyun
Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea.
J Craniofac Surg. 2010 Jan;21(1):111-6. doi: 10.1097/SCS.0b013e3181c46692.
As the survival rate of tongue cancer has increased, longer-term results of tongue reconstruction are also being considered. The aim of this study was to report the long-term outcomes of total glossectomy.Of 14 patients who underwent total glossectomy, 11 were reconstructed with the rectus abdominis musculocutaneous free flap and 3 with the anterolateral thigh free flap. We reviewed survival rate, swallowing capacity, speech intelligibility, and volume reduction in flaps. Swallowing capacity and speech intelligibility were evaluated by visual analog scale scores (7 points) at 1 to 7 years after surgery, and changes in neotongue volume were examined by dividing volume into 4 stages.The 5-year disease-specific survival rate was 71%. Almost all patients were able to eat a soft diet and resume verbal communication. However, a sufficient volume of the reconstructed tongue was decreased over the course of time. Volume change was more definitive in the cases using the anterolateral thigh free flap than the rectus abdominis musculocutaneous free flap. Neotongue volume was also correlated with swallowing capacity and speech intelligibility.In total tongue reconstruction, wide and thick flaps such as the rectus abdominis musculocutaneous flap had better outcomes. Overcorrection with a sufficient flap volume is recommended for adequate oral intake owing to volume loss caused by radiation therapy, and functional muscle transfer should also be considered to prevent muscle atrophy. Lastly, static suspension procedures are emphasized to prevent airway aspiration for larynx preservation.
随着舌癌生存率的提高，舌重建的长期效果也受到关注。本研究旨在报告全舌切除术的长期结果。14例行全舌切除术的患者中，11例采用腹直肌肌皮游离皮瓣重建，3例采用股前外侧游离皮瓣重建。我们回顾了生存率、吞咽能力、语音清晰度和皮瓣体积缩小情况。吞咽能力和语音清晰度通过术后1至7年的视觉模拟量表评分（7分制）进行评估，新舌体积变化通过将体积分为4个阶段进行检查。5年疾病特异性生存率为71%。几乎所有患者都能进食软食并恢复言语交流。然而，随着时间推移，重建舌的足够体积会减小。与腹直肌肌皮游离皮瓣相比，股前外侧游离皮瓣病例的体积变化更明显。新舌体积也与吞咽能力和语音清晰度相关。在全舌重建中，如腹直肌肌皮瓣等宽大厚实的皮瓣效果更好。由于放射治疗导致的体积丢失，建议使用足够皮瓣体积进行过度矫正以保证充足的经口摄入量，还应考虑功能性肌肉转移以防止肌肉萎缩。最后，强调采用静态悬吊手术以防止气道误吸从而保留喉功能。
