Skip to main content

Advertisement

SpringerLink
Log in

Volume and Location of the Defect as Predictors of Swallowing Outcome After Glossectomy: Correlation with a Classification

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

This study aimed to characterize the swallowing outcomes after glossectomy and analyze factors affecting them. An attempt is made to propose a classification system and corroborate it to the results. This is a cross-sectional study to assess swallowing in carcinoma tongue patients treated surgically with or without reconstruction, followed by adjuvant therapy as indicated. One hundred and six patients were evaluated with videofluoroscopy (VFS). Volume defects were classified as I: less than one-third, II: one-third to half, III: half to two-thirds, IV: two-thirds to total glossectomy. Location was assigned as lateral, tip, and sulcus defects. Predictors were T stage, surgical approach, volume, location, and adjuvant radiotherapy. Chi-square and logistic regression were used for statistical analysis. Defects were Class I, II, III, and IV in 36, 42, 16, and 12 patients, respectively. Adjuvant radiotherapy was given in 40% of cases. Mean evaluation time was 14 months from treatment. On, Functional Oral Intake Scale (FOIS) score, as the Class of the defect increased, the percentage of patients with low scores (poor swallowing outcomes) showed an increasing trend (p < 0.001). Defect volume, T stage, approach, and radiotherapy correlated significantly with an abnormality of all VFS parameters (p < 0.001). On multivariate analysis, defect volume remained an independent predictor for oral parameters; radiotherapy emerged as the only independent predictor for pharyngeal parameters. The incremental volume of the defect is a significant independent predictor of swallowing. Based on this, we propose a classification for glossectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mishra A, Meherotra R. Head and neck cancer: global burden and regional trendsin India. Asian Pac J Cancer Prev. 2014;15:537–50. https://doi.org/10.7314/apjcp.2014.15.2.537.

    Article  PubMed  Google Scholar 

  2. Shah JP, Gil Z. Current concepts in management of oral cancer-surgery. Oral Oncol. 2009;45:394–401. https://doi.org/10.1016/j.oraloncology.2008.05.017.

    Article  PubMed  Google Scholar 

  3. Urken ML, Moscoso JF, Lawson W, Biller HF. A systematic approach to functional reconstruction of the oral cavity following partial and total glossectomy. Arch Otolaryngol Head Neck Surg. 1994;120:589–601. https://doi.org/10.1001/archotol.1994.01880300007002.

    Article  CAS  PubMed  Google Scholar 

  4. Lam L, Samman N. Speech and swallowing following tongue cancer surgery and free flap reconstruction–a systematic review. Oral Oncol. 2013;49:507–24. https://doi.org/10.1016/j.oraloncology.2013.03.001.

    Article  PubMed  Google Scholar 

  5. Chang EI, Yu P, Skoracki RJ, Liu J, Hanasono MM. Comprehensive analysis of functional outcomes and survival after microvascular reconstruction of glossectomy defects. Ann Surg Oncol. 2015;22:3061–9. https://doi.org/10.1245/s10434-015-4386-6.

    Article  PubMed  Google Scholar 

  6. O’Connell DA, Rieger J, Harris JR, et al. Swallowing function in patients with base of tongue cancers treated with primary surgery and reconstructed with a modified radial forearm free flap. Arch Otolaryngol Head Neck Surg. 2008;134:857–64. https://doi.org/10.1001/archotol.134.8.857.

    Article  PubMed  Google Scholar 

  7. Brown L, Rieger JM, Harris J, Seikaly H. A longitudinal study of functional outcomes after surgical resection and microvascular reconstruction for oral cancer: tongue mobility and swallowing function. J Oral Maxillofac Surg. 2010;68:2690–700. https://doi.org/10.1016/j.joms.2010.05.004.

    Article  PubMed  Google Scholar 

  8. Borggreven PA, Verdonck-de Leeuw I, Rinkel RN, et al. Swallowing after major surgery of the oral cavity or oropharynx: a prospective and longitudinal assessment of patients treated by microvascular soft tissue reconstruction. Head Neck. 2007;29:638–47. https://doi.org/10.1002/hed.20582.

    Article  PubMed  Google Scholar 

  9. Huang ZS, Chen WL, Huang ZQ, Yang ZH. Dysphagia in tongue cancer patients before and after surgery. J Oral Maxillofac Surg. 2016;74:2067–72. https://doi.org/10.1016/j.joms.2016.03.031.

    Article  PubMed  Google Scholar 

  10. Pauloski BR, Rademaker AW, Logemann JA, et al. Surgical variables affecting swallowing in patients treated for oral/oropharyngeal cancer. Head Neck. 2004;26:625–36. https://doi.org/10.1002/hed.20013.

    Article  PubMed  Google Scholar 

  11. Pauloski BR, Rademaker AW, Logemann JA, Discekici-Harris M, Mittal BB. Comparison of swallowing function after intensity-modulated radiation therapy and conventional radiotherapy for head and neck cancer. Head Neck. 2015;37:1575–82. https://doi.org/10.1002/hed.23796.

    Article  PubMed  Google Scholar 

  12. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8. https://doi.org/10.1007/BF00417897.

    Article  CAS  PubMed  Google Scholar 

  13. Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86:1516–20. https://doi.org/10.1016/j.apmr.2004.11.049.

    Article  PubMed  Google Scholar 

  14. Engel H, Huang JJ, Lin CY, et al. A strategic approach for tongue reconstruction to achieve predictable and improved functional and aesthetic outcomes. Plast Reconstr Surg. 2010;126:1967–77. https://doi.org/10.1097/PRS.0b013e3181f44742.

    Article  CAS  PubMed  Google Scholar 

  15. Ji YB, Cho YH, Song CM, et al. Long-term functional outcomes after resection of tongue cancer: determining the optimal reconstruction method. Eur Arch Otorhinolaryngol. 2017;274:3751–6. https://doi.org/10.1007/s00405-017-4683-8.

    Article  PubMed  Google Scholar 

  16. Ansarin M, Bruschini R, Navach V, et al. Classification of glossectomies: proposal for tongue cancer resections. Head Neck. 2019;41:821–7. https://doi.org/10.1002/hed.25466.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Mannelli G, Arcuri F, Agostini T, Innocenti M, Raffaini M, Spinelli G. Classification of tongue cancer resection and treatment. J Surg Oncol. 2018;117:1092–9. https://doi.org/10.1002/jso.24991.

    Article  PubMed  Google Scholar 

  18. Joo YH, Hwang SH, Park JO, Cho KJ, Kim MS. Functional outcome after partial glossectomy with reconstruction using radial forearm free flap. Auris Nasus Larynx. 2013;40:303–7. https://doi.org/10.1016/j.anl.2012.07.012.

    Article  PubMed  Google Scholar 

  19. Lee DY, Ryu YJ, Hah JH, Kwon TK, Sung MW, Kim KH. Long-term subjective tongue function after partial glossectomy. J Oral Rehabil. 2014;41:754–8. https://doi.org/10.1111/joor.12193.

    Article  CAS  PubMed  Google Scholar 

  20. Salibian AH, Allison GR, Armstrong WB, et al. Functional hemitongue reconstruction with the microvascular ulnar forearm fap. Plast Reconstr Surg. 1999;104:654–60. https://doi.org/10.1097/00006534-199909030-00006.

    Article  CAS  PubMed  Google Scholar 

  21. Tarsitano A, Vietti MV, Cipriani R, Marchetti C. Functional results of microvascular reconstruction after hemiglossectomy: free anterolateral thigh flap versus free forearm flap. Acta Otorhinolaryngol Ital. 2013;336:374–9.

    Google Scholar 

  22. Yanai C, Kikutani T, Adachi M, Thoren H, Suzuki M, Iizuka T. Functional outcome after total and subtotal glossectomy with free flap reconstruction. Head Neck. 2008;30:909–18. https://doi.org/10.1002/hed.20804.

    Article  PubMed  Google Scholar 

  23. Montesi A, Pesaresi A, Serri L, Salmistraro D, Cavalli ML, Segoni A. Dynamic radiologic study of deglutition in oro-pharyngeal-laryngeal neoplasms and results of their treatment [in Italian]. Radiol Med. 1990;79:48–58.

    CAS  PubMed  Google Scholar 

  24. Thankappan K, Kuriakose MA, Chatni SS, et al. Lateral arm free flap for oral tongue reconstruction: an analysis of surgical details, morbidity, and functional and aesthetic outcome. Ann Plast Surg. 2011;66:261–6. https://doi.org/10.1097/SAP.0b013e3181d50e9e.

    Article  CAS  PubMed  Google Scholar 

  25. Song XM, Ye JH, Yuan Y, Zhang SY, Jiang HB, Wu YN. Radial forearm free flap for reconstruction of a large defect after radical ablation of carcinoma of the tongue and floor of the mouth: some new modifications. ORL J Otorhinolaryngol Relat Spec. 2010;72:106–12. https://doi.org/10.1159/000301155.

    Article  PubMed  Google Scholar 

  26. Hartl DM, Kolb F, Bretagne E, Bidault F, Sigal R. Cine-MRI swallowing evaluation after tongue reconstruction. Eur J Radiol. 2010;73:108–13. https://doi.org/10.1016/j.ejrad.2008.10.005.

    Article  PubMed  Google Scholar 

  27. Pauloski BR. Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am. 2008;19:889–928. https://doi.org/10.1016/j.pmr.2008.05.010.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, AIMS Ponekkara PO, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

    Shreya Bhattacharya, Krishnakumar Thankappan, Shawn T. Joseph, Sharankumar Shetty & Deepak Balasubramanian

  2. Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

    Sheejamol Velickakathu Sukumaran

  3. Division of Swallowing Therapy, Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

    Mydhili Mayadevi

  4. Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

    Subramania Iyer

Authors
  1. Shreya Bhattacharya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Krishnakumar Thankappan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shawn T. Joseph
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sheejamol Velickakathu Sukumaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sharankumar Shetty
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mydhili Mayadevi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Deepak Balasubramanian
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Subramania Iyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Krishnakumar Thankappan.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhattacharya, S., Thankappan, K., Joseph, S.T. et al. Volume and Location of the Defect as Predictors of Swallowing Outcome After Glossectomy: Correlation with a Classification. Dysphagia 36, 974–983 (2021). https://doi.org/10.1007/s00455-020-10224-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-020-10224-w

Keywords

Search

Navigation