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Recent Experience With Reconstructive Surgery Following Major Glossectomy

Recent Experience With Reconstructive Surgery Following Major Glossectomy Abstract • In an attempt to monitor the impact of new reconstructive procedures and shifting interest away from routine preoperative radiotherapy, we have reviewed the 81 patients undergoing major glossectomy and reconstruction (MGR) at the Royal Marsden Hospital, London and Surrey, England, between 1975 and 1987. While there were four marginal and 13 major reconstructive failures, 11 of the latter were successfully managed with an alternative flap, thus providing a prompt and effective palliation for most of these patients. An evolution in our choice of reconstructive procedures as well as a recent trend toward using MGR as a primary therapeutic modality were noted. Data relating to speech following reconstruction and diet rehabilitation were encouraging, particularly with the use of the latissimus dorsi flap. Survival following MGR, however, was dismal due to early local and regional recurrence. (Arch Otolaryngol Head Neck Surg 1989;115:331-338) References 1. Bakamjian V, Littlewood M: Cervical skin flaps for intraoral and pharyngeal repair following cancer surgery . Br J Surg 1964;17:191-210. 2. McGregor IA: The temporal flap in intraoral cancer: Its use in repairing the postexcisional defect . Br J Surg 1963;16:318-335. 3. Millard DR Jr: Forehead flaps in immediate repair of head, face and jaw . Am J Surg 1964; 108:508-513.Crossref 4. Ariyan S: The pectoralis major myocutaneous flap: A versatile flap for reconstruction in the head and neck . Plast Reconstr Surg 1979; 63:73-81.Crossref 5. Baek SM, Biller HF, Krespi YP, et al: The pectoralis major myocutaneous island flaps for reconstruction of the head and neck . Head Neck Surg 1979;1:293-300.Crossref 6. Ariyan S: One-stage reconstruction for defects of the mouth using a sternomastoid myocutaneous flap . Plast Reconstr Surg 1979;63:618-625.Crossref 7. Quillen CG: Latissimus dorsi myocutaneous flaps in head and neck reconstruction . Plast Reconstr Surg 1979;63:664-670.Crossref 8. Little JW III, McCulloch DT, Lyons JR: The lateral pectoral composite flap in one-stage reconstruction of the irradiated mandible . Plast Reconstr Surg 1983;71:326-337.Crossref 9. Maruyama Y, Urita Y, Ohnishi K: Riblatissimus dorsi osteomyocutaneous flap in reconstruction of a mandibular defect . Br J Plast Surg 1985;38:234-237.Crossref 10. Song R, Gao Y, Song Y, et al: The forearm flap . Clin Plast Surg 1982;9:21-26. 11. Sovtar DS, Scheker LR, Tanner NS, et al: The radial forearm flap: A versatile method for intra-oral reconstruction . Br J Plast Surg 1983; 36:1-8. 12. Allison GR, Rappaport I, Salibian AH, et al: Adaptive mechanisms of speech and swallowing after combined jaw and tongue reconstruction in long-term survival . Am J Surg 1987; 154:419-422.Crossref 13. Mogi G, Fujiyoshi T, Kurono Y, et al: Reconstructive surgery of head and neck cancer using various pedicle flaps . Auris Nasus Larynx 1985;12( (suppl 2) ):524-529. 14. Lundguist PG, Holm LE, Silversvard C, et al: Fifteen years experience with treatment of lingual carcinoma: A retrospective study . Auris Nasus Larynx 1985;12( (suppl 2) ):515-520. 15. Powers WE, Palmer LA: Biologic basis of preoperative radiation treatment . AJR 1968; 102:176-192.Crossref 16. Strong EW: Pre-operative radiation and radical neck dissection . Surg Clin North Am 1969;49:271-276. 17. Wallner PE, Hanks GE, Kramer S, et al: Patterns of care study: Analysis of outcome survey data—anterior two-thirds of tongue and floor of mouth . Am J Clin Oncol 1986;9:50-57.Crossref 18. Mantravadi RV, Skolnik EM, Applebaum EL: Complications of postoperative and pre-operative radiation therapy in head and neck cancers: A comparative study . Arch Otolaryngol Head Neck Surg 1981;107:690-693.Crossref 19. Snow JB, Gelbert RD, Kramer S, et al: Comparison of preoperative and postoperative radiation therapy for patients with carcinoma of the head and neck: Interim report . Acta Otolaryngol 1981;91:611-626.Crossref 20. Kramer S, Gelbert R, Snow J: Combined surgery and radiation therapy versus definitive radiation therapy with surgical rescue for persistent disease in patients with advanced squamous cell head and neck cancer: Final report of study . Am J Clin Oncol 1983;6( (suppl 2) ):147-148. 21. Brady LN, Davis LW: Treatment of head and neck cancer by radiation therapy . Semin Oncol 1988;15:29-38. 22. Effron MZ, Johnson JT, Myers EN, et al: Advanced carcinoma of the tongue: Management by total glossectomy without laryngectomy . Arch Otolaryngol Head Neck Surg 1981;107:694-697.Crossref 23. Harrison D: The questionable value of total glossectomy . Head Neck Surg 1983;6:632-638.Crossref 24. Vila NC, Zarate Salazar J, Molini Dezotti D, et al: Reconstruction experience with myocutaneous and osteomyocutaneous skin flaps in oncological surgery of the head and neck . J Craniomaxillofac Surg 1984;12:107-113.Crossref 25. Krespi YP, Sisson GA: Reconstruction after total or subtotal glossectomy . Am J Surg 1983;146:488-492.Crossref 26. Biller HF, Lawson W, Baek SM: Total glossectomy: A technique of reconstruction eliminating laryngectomy . Arch Otolaryngol Head Neck Surg 1983;109:69-73.Crossref 27. Rodriguez J, Point D, Esteve M, et al: Total glossectomy excluding laryngectomy for recurrence after initial radiation (two-year follow-up results) . Ann Otolaryngol Chir Cervicofac 1985; 102:421-423. 28. Gehanno P, Guédon C, Véber F, et al: Total glossectomy with preservation of larynx and immediate reconstruction: A review of 27 cases . Ann Otolaryngol Chir Cervicofac 1985; 102:183-186. 29. Magee WP Jr, McGraw JB, Horton CE, et al: Pectoralis 'paddle' myocutaneous flap: The workhorse of head and neck reconstruction . Am J Surg 1980;140:507-513.Crossref 30. Baek SM, Lawson W, Biller HF: An analysis of 133 pectoralis major myocutaneous flaps . Plast Reconstr Surg 1982;69:460-469.Crossref 31. Mehrhof A, Rosenstock A, Neifeld JP, et al: The pectoralis major myocutaneous flap in head and neck reconstruction: Analysis of complications . Am J Surg 1983;146:478-482.Crossref 32. Timmons MJ, Poole MD: Reconstructive surgery in the treatment of intraoral cancer . Br J Oral Maxillofac Surg 1986;24:77-85.Crossref 33. Sasaki CT, Gardiner LJ, Carlson RD, et al: The extended pectoralis major flap in head and neck reconstruction . Otolaryngol Head Neck Surg 1986;94:274-278. 34. Moloy PJ, Gonzales FE: Vascular anatomy of the pectoralis major myocutaneous flap . Arch Otolaryngol Head Neck Surg 1986;112:66-69.Crossref 35. Ildstao ST, Bigelow ME, Remensnyder JP: Squamous cell carcinoma of the mobile tongue: Clinical behavior and results of current therapeutic modalities . Am J Surg 1983;145:443-449.Crossref 36. Morris RL, Given KS, McCabe JS: Repair of head and neck defects with the latissimus dorsi myocutaneous flap . Am Surg 1981;47:167-173. 37. Barton FE Jr, Spicer TE, Byrd HS: Head and neck reconstruction with the latissimus dorsi myocutaneous flap: Anatomic observations and report of 60 cases . Plast Reconstr Surg 1983;71:199-204.Crossref 38. Breach NM: Orpharyngeal reconstruction: I. Cutaneous and myocutaneous flap repair , in Bloom HJG, Hanham IWF (eds): Head and Neck Oncology . New York, Raven Press, 1987, pp 109-111. 39. Mulholland MW, Megallanes F, Press BH, et al: Aggressive surgical therapy after irradiation failure in treatment of cancer of the oral tongue . Arch Surg 1984;119:394-399.Crossref 40. Jahnke V: Surgery for squamous cell carcinoma of the tongue and floor of the mouth . Auris Nasus Larynx 1985;12( (suppl 2) ):55-59. 41. Barttelbit SW, Bahn SL, Ariyan S: Rim mandibulectomy for cancer of the oral cavity . Am J Surg 1987;154:423-428.Crossref 42. Lefebvre JL, Piquet JJ, Lefebvre D, et al: The musculocutaneous flap from pectoralis major: Results of its use in a personal series of 57 cases . Ann Otolaryngol Chir Cervicofac 1984; 101:323-325. 43. Carter RL, Tanner NS, Clifford P, et al: Perineural spread in squamous cell carcinoma of the head and neck: A clinicopathological study . Clin Otolaryngol 1979;4:271-281.Crossref 44. Pange WR: Immediate reconstruction of the oral cavity , in Thawley SE, Pange WR (eds): Comprehensive Management of Head and Neck Tumors . Philadelphia, WB Saunders Co, 1987, vol 5, pp 63-95. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

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American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1989.01860270073018
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Abstract

Abstract • In an attempt to monitor the impact of new reconstructive procedures and shifting interest away from routine preoperative radiotherapy, we have reviewed the 81 patients undergoing major glossectomy and reconstruction (MGR) at the Royal Marsden Hospital, London and Surrey, England, between 1975 and 1987. While there were four marginal and 13 major reconstructive failures, 11 of the latter were successfully managed with an alternative flap, thus providing a prompt and effective palliation for most of these patients. An evolution in our choice of reconstructive procedures as well as a recent trend toward using MGR as a primary therapeutic modality were noted. Data relating to speech following reconstruction and diet rehabilitation were encouraging, particularly with the use of the latissimus dorsi flap. Survival following MGR, however, was dismal due to early local and regional recurrence. (Arch Otolaryngol Head Neck Surg 1989;115:331-338) References 1. Bakamjian V, Littlewood M: Cervical skin flaps for intraoral and pharyngeal repair following cancer surgery . Br J Surg 1964;17:191-210. 2. McGregor IA: The temporal flap in intraoral cancer: Its use in repairing the postexcisional defect . Br J Surg 1963;16:318-335. 3. Millard DR Jr: Forehead flaps in immediate repair of head, face and jaw . Am J Surg 1964; 108:508-513.Crossref 4. Ariyan S: The pectoralis major myocutaneous flap: A versatile flap for reconstruction in the head and neck . Plast Reconstr Surg 1979; 63:73-81.Crossref 5. Baek SM, Biller HF, Krespi YP, et al: The pectoralis major myocutaneous island flaps for reconstruction of the head and neck . Head Neck Surg 1979;1:293-300.Crossref 6. Ariyan S: One-stage reconstruction for defects of the mouth using a sternomastoid myocutaneous flap . Plast Reconstr Surg 1979;63:618-625.Crossref 7. Quillen CG: Latissimus dorsi myocutaneous flaps in head and neck reconstruction . Plast Reconstr Surg 1979;63:664-670.Crossref 8. Little JW III, McCulloch DT, Lyons JR: The lateral pectoral composite flap in one-stage reconstruction of the irradiated mandible . Plast Reconstr Surg 1983;71:326-337.Crossref 9. Maruyama Y, Urita Y, Ohnishi K: Riblatissimus dorsi osteomyocutaneous flap in reconstruction of a mandibular defect . Br J Plast Surg 1985;38:234-237.Crossref 10. Song R, Gao Y, Song Y, et al: The forearm flap . Clin Plast Surg 1982;9:21-26. 11. Sovtar DS, Scheker LR, Tanner NS, et al: The radial forearm flap: A versatile method for intra-oral reconstruction . Br J Plast Surg 1983; 36:1-8. 12. Allison GR, Rappaport I, Salibian AH, et al: Adaptive mechanisms of speech and swallowing after combined jaw and tongue reconstruction in long-term survival . Am J Surg 1987; 154:419-422.Crossref 13. Mogi G, Fujiyoshi T, Kurono Y, et al: Reconstructive surgery of head and neck cancer using various pedicle flaps . Auris Nasus Larynx 1985;12( (suppl 2) ):524-529. 14. Lundguist PG, Holm LE, Silversvard C, et al: Fifteen years experience with treatment of lingual carcinoma: A retrospective study . Auris Nasus Larynx 1985;12( (suppl 2) ):515-520. 15. Powers WE, Palmer LA: Biologic basis of preoperative radiation treatment . AJR 1968; 102:176-192.Crossref 16. Strong EW: Pre-operative radiation and radical neck dissection . Surg Clin North Am 1969;49:271-276. 17. Wallner PE, Hanks GE, Kramer S, et al: Patterns of care study: Analysis of outcome survey data—anterior two-thirds of tongue and floor of mouth . Am J Clin Oncol 1986;9:50-57.Crossref 18. Mantravadi RV, Skolnik EM, Applebaum EL: Complications of postoperative and pre-operative radiation therapy in head and neck cancers: A comparative study . Arch Otolaryngol Head Neck Surg 1981;107:690-693.Crossref 19. Snow JB, Gelbert RD, Kramer S, et al: Comparison of preoperative and postoperative radiation therapy for patients with carcinoma of the head and neck: Interim report . Acta Otolaryngol 1981;91:611-626.Crossref 20. Kramer S, Gelbert R, Snow J: Combined surgery and radiation therapy versus definitive radiation therapy with surgical rescue for persistent disease in patients with advanced squamous cell head and neck cancer: Final report of study . Am J Clin Oncol 1983;6( (suppl 2) ):147-148. 21. Brady LN, Davis LW: Treatment of head and neck cancer by radiation therapy . Semin Oncol 1988;15:29-38. 22. Effron MZ, Johnson JT, Myers EN, et al: Advanced carcinoma of the tongue: Management by total glossectomy without laryngectomy . Arch Otolaryngol Head Neck Surg 1981;107:694-697.Crossref 23. Harrison D: The questionable value of total glossectomy . Head Neck Surg 1983;6:632-638.Crossref 24. Vila NC, Zarate Salazar J, Molini Dezotti D, et al: Reconstruction experience with myocutaneous and osteomyocutaneous skin flaps in oncological surgery of the head and neck . J Craniomaxillofac Surg 1984;12:107-113.Crossref 25. Krespi YP, Sisson GA: Reconstruction after total or subtotal glossectomy . Am J Surg 1983;146:488-492.Crossref 26. Biller HF, Lawson W, Baek SM: Total glossectomy: A technique of reconstruction eliminating laryngectomy . Arch Otolaryngol Head Neck Surg 1983;109:69-73.Crossref 27. Rodriguez J, Point D, Esteve M, et al: Total glossectomy excluding laryngectomy for recurrence after initial radiation (two-year follow-up results) . Ann Otolaryngol Chir Cervicofac 1985; 102:421-423. 28. Gehanno P, Guédon C, Véber F, et al: Total glossectomy with preservation of larynx and immediate reconstruction: A review of 27 cases . Ann Otolaryngol Chir Cervicofac 1985; 102:183-186. 29. Magee WP Jr, McGraw JB, Horton CE, et al: Pectoralis 'paddle' myocutaneous flap: The workhorse of head and neck reconstruction . Am J Surg 1980;140:507-513.Crossref 30. Baek SM, Lawson W, Biller HF: An analysis of 133 pectoralis major myocutaneous flaps . Plast Reconstr Surg 1982;69:460-469.Crossref 31. Mehrhof A, Rosenstock A, Neifeld JP, et al: The pectoralis major myocutaneous flap in head and neck reconstruction: Analysis of complications . Am J Surg 1983;146:478-482.Crossref 32. Timmons MJ, Poole MD: Reconstructive surgery in the treatment of intraoral cancer . Br J Oral Maxillofac Surg 1986;24:77-85.Crossref 33. Sasaki CT, Gardiner LJ, Carlson RD, et al: The extended pectoralis major flap in head and neck reconstruction . Otolaryngol Head Neck Surg 1986;94:274-278. 34. Moloy PJ, Gonzales FE: Vascular anatomy of the pectoralis major myocutaneous flap . Arch Otolaryngol Head Neck Surg 1986;112:66-69.Crossref 35. Ildstao ST, Bigelow ME, Remensnyder JP: Squamous cell carcinoma of the mobile tongue: Clinical behavior and results of current therapeutic modalities . Am J Surg 1983;145:443-449.Crossref 36. Morris RL, Given KS, McCabe JS: Repair of head and neck defects with the latissimus dorsi myocutaneous flap . Am Surg 1981;47:167-173. 37. Barton FE Jr, Spicer TE, Byrd HS: Head and neck reconstruction with the latissimus dorsi myocutaneous flap: Anatomic observations and report of 60 cases . Plast Reconstr Surg 1983;71:199-204.Crossref 38. Breach NM: Orpharyngeal reconstruction: I. Cutaneous and myocutaneous flap repair , in Bloom HJG, Hanham IWF (eds): Head and Neck Oncology . New York, Raven Press, 1987, pp 109-111. 39. Mulholland MW, Megallanes F, Press BH, et al: Aggressive surgical therapy after irradiation failure in treatment of cancer of the oral tongue . Arch Surg 1984;119:394-399.Crossref 40. Jahnke V: Surgery for squamous cell carcinoma of the tongue and floor of the mouth . Auris Nasus Larynx 1985;12( (suppl 2) ):55-59. 41. Barttelbit SW, Bahn SL, Ariyan S: Rim mandibulectomy for cancer of the oral cavity . Am J Surg 1987;154:423-428.Crossref 42. Lefebvre JL, Piquet JJ, Lefebvre D, et al: The musculocutaneous flap from pectoralis major: Results of its use in a personal series of 57 cases . Ann Otolaryngol Chir Cervicofac 1984; 101:323-325. 43. Carter RL, Tanner NS, Clifford P, et al: Perineural spread in squamous cell carcinoma of the head and neck: A clinicopathological study . Clin Otolaryngol 1979;4:271-281.Crossref 44. Pange WR: Immediate reconstruction of the oral cavity , in Thawley SE, Pange WR (eds): Comprehensive Management of Head and Neck Tumors . Philadelphia, WB Saunders Co, 1987, vol 5, pp 63-95.

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Mar 1, 1989

References