Background: The tongue plays an essential role in speech, swallowing and airway protection. Appropriate tongue reconstruction is critical to maximize a patient’s post-operative function. However, outcomes data on the effectiveness of tongue reconstruction frequently relies on gross measures of performance such as G-tube dependence or time for deglutition, without further analysis of why the patient is struggling (i.e. poor oral competence, poor tongue mobility, etc.) Our objective with this study was to characterize post-reconstruction function using patient-reported outcomes and objective measures across all tongue defects and reconstructive techniques, to try and identify optimal reconstructive strategies and patterns of failure.
Methods: We performed a single institution, prospective study of patients who underwent glossectomy for oral cavity malignancy. Data was collected prior to surgery, 1, and 6 months after surgery.
Patient-reported outcomes were assessed by the Speech Handicap Index (SHI), MD Anderson Dysphagia Index (MDADI) and University of Washington Quality of Life questionnaire (UWQoL). Patients were also evaluated by a speech-language pathologist to assess intelligibility of words and sentences as well as oral competence and measures of tongue strength, mobility and coordination.
Results: A total of 32 patients were included. Average age was 57.41 years (SD=13.01) with 59.4% males. Nine percent of patients were Black and 87.5% White. Thirty-one percent were deceased at 3 years. Twenty-seven underwent a hemiglossectomy or less, while the remainder underwent a subtotal or total glossectomy. Only one patient had a concurrent mandible resection. Two had a concurrent base of tongue or oropharyngeal resection. Reconstruction was performed with primary closure / locoregional rotation flap (n = 6), an anterolateral thigh free flap (n = 12) or a radial forearm free flap (n = 14).
Pre-operatively, the mean SHI score was 22.45 (SD=17.98) across all patients. One month post-operatively, this had declined to 34.57 (SD=16.70). Similar trends were seen with the MDADI global (pre mean=3.60, SD=1.13, post mean=3.33, SD=1.36, 6m post mean=3.38, SD=0.92) and the UWQoL composite score (pre mean=53.04, SD=19.32, post mean=58.33, SD=19.16, 6m post mean=54.90, SD=9.37).
Speech articulation was excellent pre-operatively (words=45.90, SD=4.03, sentences=215.68, SD=5.57) but declined in the immediate post-operative period (words =36.48, SD=10.63, sentences=203.85, SD=21.76). By 6 months after surgery, there was some improvement (words=37.75, SD=14.50, sentences=208.50, SD=19.65). Surprisingly, we found that conversational fluency was essentially unchanged (pre mean=3.90, SD=0.41, post mean=3.43, SD=0.93). Tongue mobility also experiences a similar decline in the post-operative period (pre mean=8.06, SD=1.75, post mean=6.10, SD=1.84), and does not appear to improve at 6 months after surgery (mean=5.75, SD=2.49).
Conclusions: In this study, we attempt to evaluate tongue function following glossectomy and reconstruction. All patients report initial declines in function, which is matched by declines in objective function. There is some restoration in function with time (i.e. speech intelligibility) but some functions, do not appear to improve (tongue mobility).