Change search
ReferencesLink to record
Permanent link

Direct link
Free radial forearm flap reconstruction in surgery of the oral cavity and pharynx: surgical complications, impairment of speech and swallowing.
Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
1994 (English)In: Clinical Otolaryngology, ISSN 1749-4478, Vol. 19, no 1, 28-34 p.Article in journal (Refereed) Published
Abstract [en]

The first 100 consecutive free radial forearm flaps used in reconstruction for oral and pharyngeal cancer were investigated. Seven re-operations took place due to circulatory impairment of the flap. Two flaps underwent partial, and four total necrosis, one of those patients died of massive haemorrhage. Post-operative infection was significantly correlated to increased time between the last radiotherapy session and surgery. All but eight patients had post-operative impairment of swallowing and all but five patients had impairment of speech articulation or hypernasality. Post-operative time spent in hospital was a range of 12-122 days (mean 37 days). The 2-year survival rate was 70% and the 5-year survival rate was 45%.

Place, publisher, year, edition, pages
1994. Vol. 19, no 1, 28-34 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:umu:diva-3951OAI: diva2:142870
Available from: 2004-05-07 Created: 2004-05-07 Last updated: 2010-02-24Bibliographically approved
In thesis
1. Impairment of intra-oral sensation, discrimination ability, and swallowing function following radiotherapy and surgery for oral and pharyngeal cancer
Open this publication in new window or tab >>Impairment of intra-oral sensation, discrimination ability, and swallowing function following radiotherapy and surgery for oral and pharyngeal cancer
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Oral and pharyngeal cancer is commonly treated with a combination of radiotherapy and surgery. It is a clinical knowledge that patients often experience severe swallowing disorders following treatment. Since surgical sequelae are instantaneous and obvious, little attention has been paid to other concurrent effects of the treatment. To shed light on this subject, the aim of this thesis was twofold (i) to make a retrospective inventory of the sequelae following treatment and (ii) to perform a prospective, inceptive examination at diagnosis, and to follow-up after radiotherapy, six months and 12 months after surgery.

The files of ninety-nine patients revealed that following treatment one-third had to use gastric fistulas and more than nine of ten patients had restricted swallowing capacity. Every second patient could only swallow puréed or liquid food.

Adequate intra-oral sensation and discrimination ability is essential for bolus preparation and bolus control, for appropriate elicitation of the swallowing reflex and, hence, for the oral phase of swallowing. At the inceptive examination, the prospective part of the study demonstrated intra-oral discrimination ability in patients was equal to that in healthy controls but was impaired six months after treatment and there was no significant improvement after 12 months. It had been expected that the patient’s healthy, non-tumor side would compensate but it did not. An explanation was found when it was revealed that radiotherapy induced a delayed decline in intra-oral sensation. Sensory decline was not demonstrated within a month after radiotherapy but was manifest six months later. Since the radiotherapy field includes the neck, because of the risk for metastasis, it is highly plausible that pharyngeal sensation declines in a manner corresponding to that found intra-orally when the healthy side is irradiated. In accord with this presumption, pharyngeal swallowing function deteriorated in patents with oral tumors. Cineradiographic evaluation of oral and pharyngeal swallowing function disclosed a significant association between the degree of swallowing dysfunction and the degree of sensory decline and with the degree of impairment of shape recognition.

Conclusions: Delayed intra-oral sensory decline, found to be induced by radiotherapy, can be expected to appear in the entire radiation field, including the oral cavity and the pharynx, with adverse effect on swallowing. Testing intra-oral sensation close to the last radiotherapy session is not advisable, because sensory decline does not develop immediately after radiotherapy but manifests after six months. Spontaneous sensory rehabilitation cannot be expected after six months. The significant association between degree of swallowing dysfunction and degree of intra-oral sensory decline and impaired discrimination ability must be considered in the quest for functional rehabilitation of patients treated for oral or pharyngeal cancer.

112 p.
Umeå University odontological dissertations, ISSN 0345-7532 ; 85
Medical sciences, Oral cancer, pharyngeal cancer, radiotherapy, surgery, intra-oral sensation, sensibility, swallowing, intra-oral discrimination, deglutition disorders, dysphagia, function, dysfunction, radiography, cineradiography, follow-up, MEDICIN OCH VÅRD
National Category
Medical and Health Sciences
Research subject
Diagnostic Radiology
urn:nbn:se:umu:diva-266 (URN)91-7305-651-0 (ISBN)
Public defence
2004-06-02, 260, 3A, Norrlands Universitetssjukhus, Umeå, 13:00 (English)
Available from: 2004-05-07 Created: 2004-05-07 Last updated: 2010-02-24Bibliographically approved

Open Access in DiVA

No full text

Other links
By organisation
Oral and Maxillofacial Radiology
In the same journal
Clinical Otolaryngology
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 77 hits
ReferencesLink to record
Permanent link

Direct link