Functional and quality of life outcomes after partial glossectomy: a multi-institutional longitudinal study of the head and neck research network

Background: While aggressive treatment for oral cancer may optimize survival, decrements in speech and swallowing function and quality of life often result. This exploratory study investigated how patients recover their communicative function, swallowing ability, and quality of life after primary surgery [with or without adjuvant (chemo) radiation therapy] for tongue cancer over the course of the first year post-operation.Methods: Patients treated for oral cancer at three institutions (University of Alberta Hospital, Mount Sinai Beth Israel Medical Center, and Turku University Hospital) were administered patient-reported outcomes assessing speech [Speech Handicap Index (SHI)], swallowing [(M.D. Anderson Dysphagia Inventory (MDADI)] and quality of life [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC-H&N35)]. Outcome measures were completed pre-operatively and at 1-, 6-, and 12-months post-operatively.Results: One hundred and seventeen patients undergoing partial glossectomy with reconstruction participated in this study. Results indicated no significant differences in swallowing function (MDADI and EORTC-H& N35 subscales) between baseline and 6 months post-surgery and no significant differences in speech function (SHI subscales) between baseline and 1 year post-surgery. Most quality of life domains (EORTC-H& N35 subscales) returned to baseline levels by 1 year post-operation, while difficulties with dry mouth and sticky saliva persisted. A clear time trend of adjuvant (chemo) radiation therapy negatively affecting dry mouth scores over time was identified in this study, while negative independent effects of chemoradiation on MDADI swallowing, and EORTC-H& N35 swallowing, eating, and opening mouth subscales were found.Conclusions: Assessment time influenced patient-reported speech, swallowing, and quality of life outcomes, while treatment (by time) effects were found for only swallowing and quality of life outcomes. Results of the present study will help guide clinical care and will be useful for patient counseling on expected short and long-term functional and quality of life outcomes of surgical and adjuvant treatment for oral cavity cancer

Comparison of Speech and Resonance Outcomes Across Three Methods of Treatment for Maxillary Defects

Purpose: Treatment of maxillary defects, whether by prosthetic rehabilitation or surgical reconstruction, should aim to restore speech function and resonance balance. With the advent of technology and changing clinical practices related to maxillary defect management, speech outcomes need to be evaluated and compared in order to determine efficacy of differing approaches.  Materials and Methods: One hundred and four patients across three treatment groups for maxillary defects were included: 38 patients who were treated with maxillary obturators (OBT group), 39 patients who were treated with a standard fibular free flap reconstruction that did not involve digital planning of the reconstruction (Standard group) and 27 patients who were reconstructed using a digitally planned surgical design and simulation fibular free flap reconstruction (SDS group). Speech assessments were completed to assess word and sentence intelligibility, resonance balance and aeromechanical orifice estimation among these three groups. Assessments included the Computerized Assessment of Intelligibility of Dysarthric Speech (C-AIDS), nasalance scores via the Nasometer and palatopharyngeal orifice area via the PERCI-SARS. Results: Significant differences were found in word intelligibility between the SDS and the Standard groups (p =.035) and on nasalance scores between the SDS and the OBT groups (p=.027). Conclusions: Patients treated with digital reconstruction (SDS) had better speech outcomes than the other two treatment groups, whose mean scores on certain speech variables were not within normal limits. Speech outcomes in the SDS group were consistently within the normal range across all measured speech variables