Speech and swallowing following tongue cancer surgery and free flap reconstruction--a systematic review.

Background:Successful tongue reconstruction should restore swallowing, speech function, and cosmesis. The purpose of this prospective study was to evaluate the functional and aesthetic outcomes of tongue reconstruction using variable free flaps based on different tongue defects.Methods:One hundred f

A strategic approach for tongue reconstruction to achieve predictable and improved functional and aesthetic outcomes.

Background
A Speech Handicap Index (SHI) questionnaire with 30 items on speech problems was developed and validated in 92 patients with cancer of the oral cavity or pharynx and 110 healthy subjects.

Methods
All subjects completed the SHI and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire–Head & Neck module (QLQ-H&N35). Twenty-nine patients completed the SHI twice to assess test–retest reliability.

Results
Factor analysis identified 2 well-defined subscales, assessing speech function and psychosocial functioning related to speech. Internal consistency and test–retest reliability were high. Construct validity was evidenced by its ability to distinguish between patient subgroups formed on the basis of tumor grade. A cut-off score of 6 points was defined to identify patients with speech problems.

Conclusions
Results of this initial psychometric study indicate that the SHI is a reliable and valid questionnaire for assessing speech problems. Additional research is needed to evaluate responsiveness of the questionnaire to changes in speech-related problems over time. © 2008 Wiley Periodicals, Inc. Head Neck, 2008

Speech Handicap Index in patients with oral and pharyngeal cancer: Better understanding of patients' complaints

Background. The aim of this study was to analyze swallowing outcome in advanced oral/oropharyngeal cancer patients treated with microvascular reconstructive surgery and adjuvant radiotherapy. Methods. Eighty patients were included. Patient, tumor, and treatment factors were assessed. Postoperative videofluoro- scopic swallowing studies (VFSS) and scintigraphy tests were performed at 6 (n ¼ 54 vs 44) and 12 (n ¼ 32 vs 37) months. Swallowing parameters such as the oropharyngeal swallow efficiency and the Penetration/Aspiration Scale were analyzed. Results. Impaired swallowing status was found at 6 months, which remained stationary at 12 months. Comorbid condition, larger tumors (T3-T4 vs T2), and resections of the base of tongue and soft palate combined (vs defects of other dynamic structures) were associated with most profound swallowing problems (p < .05). Conclusions. Swallowing difficulties are relatively frequent and can to a large extent be predicted. With the knowledge of this study, better counseling and vigilance as to swallowing diffi-

Swallowing after major surgery of the oral cavity or oropharynx: a prospective and longitudinal assessment of patients treated by microvascular soft tissue reconstruction.

Background. The aim of the study was to analyze speech outcome for patients with advanced oral/oropharyn- geal cancer treated with reconstructive surgery and adju- vant radiotherapy. Methods. Speech tests (communicative suitability, intelligi- bility, articulation, nasality, and consonant errors) were per- formed in a control group and in patients before treatment (n = 76), and 6 months (n = 51) and 12 months (n = 42) af- ter treatment. Results. Speech tests were significantly worse for patients before and after treatment compared with the controls. Speech did not improve between 6 and 12 months. After treatment, patients with T3-4 tumors showed a significantly worse score for communicative suitability, intelligibility, and articulation than patients with T2 tumors. No significant differences were found for subsites after treatment, although patients with mobile tongue tumors showed the best results. Conclusion. Speech difficulties are significant, and with the knowledge of this study better counseling and vigilance as to speech difficulties may be possible in patients undergoing treatment for oral/oropharyngeal cancer. A 2005 Wiley Period- icals, Inc. Head Neck 27: 785-793, 2005

Speech outcome after surgical treatment for oral and oropharyngeal cancer: a longitudinal assessment of patients reconstructed by a microvascular flap.

Swallowing, speech, and morbidity were assessed postoperatively in 25 patients, 18 of whom had had intraoral defects reconstructed by lateral upper arm free flaps (LUFF) and 7 by radial forearm free flaps (RFFF). Video fluoroscopy was used to assess swallowing, the Freiburger audiometric test to assess speech; and measurement of arm circumference to assess donor site morbidity. A questionnaire was used to evaluate swallowing, speech, and donor site morbidity subjectively. The degree of impairment in swallowing depended on the site of resection. Anterior and posterior resections affected swallowing more than lateral resections. Anterior resection and the use of LUFFs reduced intelligibility. There was no significant difference in impairment between LUFF and RFFF. We conclude that the LUFFs are superior to RFFFs because they can be closed primary and the incidence of donor site morbidity is slight.

Swallowing and speech function after intraoral soft tissue reconstruction with lateral upper arm free flap and radial forearm free flap.

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Swallowing and speech function after intraoral soft tissue reconstruction with lateral upper arm free flap and radial forearm free flap.