Comparison of flap reconstruction and primary closure in T1/2 tongue carcinoma regarding posttherapeutic function, survival, and gender

Background Flap reconstruction of the tongue is performed in a variety of small carcinomas despite minimal tissue loss. Resulting functional or survival improvements as well as gender specific differences remain unclear.

Methods In 384 surgically treated tongue carcinoma patients, TNM classification, therapy, survival, and gender were retrospectively assessed. Functional analyses were performed on 55 of these patients. Inclusion criteria were surgically treated T1/2 tongue carcinoma with primary closure or reconstruction via radial forearm flap. Objective and subjective tests were performed for swallowing function (100 ml water swallow test, MDADI, RTOG dietary changes, nasal penetration), speech (SHI), dry mouth (Saxon test, VAS Xerostomia), quality of life (EORTC QLQ H&N35), and mouth opening (maxilla mandibula distance, Mallampati).

Results Of the 384 patients retrospectively analyzed (226 primary closure, 158 flap reconstruction) the reconstructed group showed a significantly higher proportion of women, 38% vs. 26% (p=0.02). Survival analysis of T1/2 carcinomas showed no benefit from flap reconstruction (p=0.47). Functional analysis demonstrated no significant difference between the groups in any of the areas studied (p>0.05).

Discussion We showed for the first time that women were significantly more likely to receive flap reconstruction. This is plausible due to the proportionally larger tumor at smaller tongue and oral cavity. Regarding survival and functional outcome, flap reconstruction in early tumor stages shows no advantage. Thus, the indication for flap reconstruction in these stages should be made critically and gender-specific and functional aspects should be considered.

Publication History

Article published online:
24 May 2022