Analysis of Swallowing After Retromolar or Oropharynx and Reconstruction with Myocutaneos or Microvascular Free Flaps

ABSTRACT

Objective: Evaluate swallowing in retromolar or oropharyngeal cancer patients submitted to surgical resection and microvascular free flap (MFF) or pedicled myocutaneous flap (MC) reconstruction. Study Retrospective case series. Patients and methods:Eighteen previously untreated patients with squamous cell carcinoma of the retromolar area or oropharynx submitted to surgical treatment and reconstruction between January. 2000 and July, 2003, were submitted to videofluoroscopic evaluation.The reconstruction was performed with MFF in 12 cases and MC in 6 cases. Parameters analyzed were oropharyngeal motility alterations, stasis, laryngeal penetration and/or aspiration and dysphagia severity. Results: Oral phase was worsefor MC than for MFF patients, with premature bolus leakage (66.7% and 16.7%), increased oral transit time (66.7% and 16.7%), reduced anterior-posterior tongue movement (66.7% and 25%), nasal regurgitation (50% and 0%) and oral stasis (83.3% and 41.6%), respectively. In pharyngeal phase, results were similar in both groups. Main alterations in MFF andMC were, respectively, pharyngeal swallowing delay (83.3% and 100%), nasal regurgitation (58.3% and 83.3%), increased pharyngeal transit time (50% and 83.3%), reduced laryngeal elevation (41.7% and 66.7%), pharyngeal stasis (50% and16.7%) and laryngeal aspiration (50% and 66.7%). Conclusion: Oropharyngeal swallowing after retromolar or oropharyngeal cancer surgery seems to differ depending on the type of reconstruction. Microvascular free flaps seemed to allow a more efficient oropharyngeal deglutition.