Benjamin Martin, Aliano Kristen, Davenport Thomas, Frank Douglas
Long Island Jewish Medical Center, New York, NY.
Ann Plast Surg. 2020 Jul;85(S1 Suppl 1):S76-S79. doi: 10.1097/SAP.0000000000002346.
The surgical management and reconstruction after ablation of squamous cell carcinoma of the oral tongue and floor of mouth are quite challenging. If not reconstructed properly, the deficits resulting from the extirpation of even relatively small (T1 and T2) tumors of the tongue can impact speech and deglutition via tongue tethering and poor anterolateral mobility. Functional outcome studies regarding the utility of the pedicled facial artery musculamucosal (FAMM) flap for reconstruction of partial glossectomy defects are limited.
This is a retrospective single institutional study of patients who underwent FAMM flap reconstruction for oral cavity defects resulting from partial glossectomy (2009-2013). Follow-up data included postoperative complications, defect size, operative time, and subjective functional results (tongue mobility, speech, and swallowing capabilities).The MD Anderson Dysphagia Inventory and a limited self-assessment of speech were sent to all living patients in this initial tongue cancer cohort to assess aspects of functional status.
Of the 21 patients studied in this initial FAMM flap cohort, 18 are currently living. The MD Anderson Dysphagia Inventory and a limited self-assessment survey of speech were sent to these individuals 6 months after treatment completion. Eight patients (44%) returned completed questionnaires. All of the respondents disagreed or strongly disagreed with the statement that they felt excluded from others because of their eating habits, 6 of the 8 of the respondents stated that they disagreed or strongly disagreed with the statement that they have to limit their food intake, and none felt that others were irritated by their eating habits. All felt that their speech was either good, very good, or excellent. No surveyed patient reported having job difficulty because of their speech.
The FAMM flap is a reliable alternative for reconstruction of small oral tongue defects without functional deficits and a great alternative to free flap reconstruction of medium-sized defects. The encouragement of patient functional outcome studies and longitudinal follow-up studies need to be conducted in efforts to best tailor a reconstruction plan for patients with oral tongue cancers.
口腔舌部和口底鳞状细胞癌切除术后的手术管理与重建颇具挑战性。若重建不当，即便切除相对较小（T1和T2）的舌部肿瘤所导致的缺损，也可能通过舌系带缩短和前外侧活动度欠佳影响言语和吞咽功能。关于带蒂面动脉肌黏膜（FAMM）瓣用于部分舌切除术缺损重建效用的功能结局研究有限。
这是一项针对因部分舌切除术导致口腔缺损而接受FAMM瓣重建的患者（2009 - 2013年）的回顾性单机构研究。随访数据包括术后并发症、缺损大小、手术时间以及主观功能结果（舌活动度、言语和吞咽能力）。向该初始舌癌队列中的所有在世患者发送MD安德森吞咽量表和有限的言语自我评估，以评估功能状态方面。
在这个初始FAMM瓣队列研究的21例患者中，目前有18例在世。在治疗完成6个月后，向这些患者发送了MD安德森吞咽量表和有限的言语自我评估调查问卷。8例患者（44%）返回了完整问卷。所有受访者均不同意或强烈不同意他们因饮食习惯而感到被他人排斥的说法，8名受访者中有6人表示不同意或强烈不同意他们必须限制食物摄入量的说法，且无人觉得他人因他们的饮食习惯而恼怒。所有人都认为自己的言语良好、非常好或极好。没有接受调查的患者报告因言语问题而在工作上遇到困难。
FAMM瓣是重建小型口腔舌部缺损且无功能缺陷的可靠替代方案，也是中型缺损游离瓣重建的良好替代方案。需要鼓励开展患者功能结局研究和纵向随访研究，以便为口腔舌癌患者量身定制最佳重建方案。
