Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Michigan Health System, Ann Arbor, MI, United States.
Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
Oral Oncol. 2023 Jul;142:106431. doi: 10.1016/j.oraloncology.2023.106431. Epub 2023 May 30.
The goal was to characterize four clinically distinct glossectomy defects to establish significant quantitative cut points using functional metrics, the MD Anderson Dysphagia Index (MDADI) and speech intelligibility.
Population included 101 patients treated with surgery, adjuvant radiation per NCCN guidelines, and ≥ 12 months follow-up.
Defect groups: subtotal hemiglossectomy (1), hemiglossectomy (2), extended hemiglossectomy (3) and oral glossectomy (4) were compared: All outcomes supported a four defect model. Intergroup comparison of outcomes with subtotal hemiglossectomy as reference (p value): Tongue Protrusion <0.001,<0.001,<0.001; Elevation <0.001,<0.001,<0.001; Open Mouth Premaxillary Contact Elevation <0.001,<0.001,<0.001; Obliteration 0.6,<0.001,<0.001; Normalcy of Diet, <0.3,<0.001,<0.001; Nutritional Mode, <0.9,<0.8,<0.001; Range of Liquids, <0.4,<0.016,<0.02; Range of Solids, <0.5,<0.004,<0.001; Eating in Public, <0.2,<0.002,<0.03; Understandability of Speech, <0.9,<0.001,<0.001; Speaking in Public, <0.4,<0.03,<0.001; MDADI, <0.4,<0.005,<0.01; Single Word Intelligibility, <0.4,<0.1,<0.001; Sentence Intelligibility, <0.5,<0.08,<0.001; Words Per Minute Intelligibility, <0.6,<0.04,<0.001; Sentence Efficiency Ratio, <0.4,<0.03,<0.002. Proportion of patients by 4 defect groups who underwent: tissue transplantation, 51%,93.9%,100%,100%.Radiation,24%,67%,88%,80%.Between hemiglossectomy and extended hemiglossectomy, the defect extends into the contralateral floor of the mouth and/or the anterior tonsillar pillar; resection of these subunits limits tongue mobility with an impact on functional outcome and MDADI. Between extended hemiglossectomy and oral glossectomy, the defect extends to include the tip of the tongue and appears to impact functional outcome and MDADI.
Subtotal hemiglossectomy, hemiglossectomy, extended glossectomy and oral glossectomy are associated with quantitative (elevation, protrusion, open mouth premaxillary contact and obliteration), qualitative (speech and swallowing) and MDADI differences, suggesting that these 4 ordinal defect groups are distinct.
通过使用功能指标（MD Anderson 吞咽障碍指数（MDADI）和言语可懂度）来表征四个临床不同的舌切除术缺陷，确定有意义的定量截断点。
研究人群包括 101 名接受手术治疗、根据 NCCN 指南接受辅助放疗且随访时间≥12 个月的患者。
缺陷组：部分舌切除术（1）、舌切除术（2）、扩展舌切除术（3）和口腔舌切除术（4）的比较：所有结果均支持四缺陷模型。与部分舌切除术相比，各组间的结果比较（p 值）：舌伸出<0.001，<0.001，<0.001；抬高<0.001，<0.001，<0.001；张口前上颌接触抬高<0.001，<0.001，<0.001；闭塞 0.6，<0.001，<0.001；饮食正常性，<0.3，<0.001，<0.001；营养模式，<0.9，<0.8，<0.001；液体范围，<0.4，<0.016，<0.02；固体范围，<0.5，<0.004，<0.001；在公共场合进食，<0.2，<0.002，<0.03；言语可懂度，<0.9，<0.001，<0.001；在公共场合说话，<0.4，<0.03，<0.001；MDADI，<0.4，<0.005，<0.01；单字可懂度，<0.4，<0.1，<0.001；句子可懂度，<0.5，<0.08，<0.001；每分钟单词可懂度，<0.6，<0.04，<0.001；句子效率比，<0.4，<0.03，<0.002。按四组缺陷分类，接受组织移植的患者比例为：51%、93.9%、100%、100%；接受放疗的患者比例为：24%、67%、88%、80%。半舌切除术和扩展舌切除术之间，缺陷延伸到对侧口底和/或前扁桃体柱；切除这些亚单位会限制舌的活动度，从而影响功能结局和 MDADI。在扩展舌切除术和口腔舌切除术之间，缺陷延伸到包括舌尖，并似乎影响功能结局和 MDADI。
部分舌切除术、舌切除术、扩展舌切除术和口腔舌切除术与定量（抬高、伸出、张口前上颌接触和闭塞）、定性（言语和吞咽）和 MDADI 差异相关，表明这 4 个有序缺陷组是不同的。
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