[Functional reconstruction after total or near total glossectomy].

Objective: To evaluate the functional outcomes of patients who underwent total or near total glossectomy with pectoralis major myocutaneous flap (PMMF) or free flap (FF) reconstruction.

Methods: Retrospective study of 38 consecutive patients undergoing total or near total glossectomy with PMMF or FF reconstruction. The outcomes of decannulation, feeding and speech function recovery were compared.

Results: Near total glossectomy was performed in 33 patients and total glossectomy was performed in 5 patients. Twenty five patients underwent reconstruction with PMMF including 2 salvage reconstructions after free flaps failure. All PMMFs survived except one complete necrosis. The success rate of PMMF was 96.0% (24/25). Fifteen patients underwent reconstruction with FF. Two flaps developed complete necrosis and the success rate of FF was 86.7% (13/15). The difference in the rates between the two groups was not significant (P=0.545). In the PMMF and FF groups, the renewal of oral feeding were 65.2% (15/23) and 100% (13/13), P<0.05, and the tracheostomy decannulation were 52.2% (12/23) and 100% (12/12), P<0.05, respectively. Postoperative feeding function recovery was better in FF group than that in PMMF group (P=0.011). Single factor analysis showed that using FF and maintaining the continuity of the mandible were related to successful rate of renewal of oral feeding. Multivariate Logistic regression analysis showed that the continuity of the mandible was the only independent predictor for renewal of oral feeding. There was no significant difference in the postoperative speech functions between the two groups.

Conclusions: The continuity of the mandible is the major factor to restore the functional outcomes in feeding after total or near total glossectomy. Compared with PMMF, using FF is more beneficial to retain or rebuild the continuity of the mandible.