A prospective observational study to compare speech and swallowing outcomes in different types of oral tongue defects and reconstructions in patients undergoing treatment for oral tongue squamous cell carcinoma.

Abstract

11113 Background: The tongue is an important organ for speech and swallowing functions. Oral tongue squamous cell carcinoma (OTSCC) can per se affect these functions. Surgery followed by adjuvant treatment may further influence these functions. Methods: In this prospective study (CTRI/2020/01/023080) we aimed to assess the speech and swallowing outcomes of 100 treatment-naive OTSCC patients receiving the standard care at our center and compare these outcomes with the type of reconstruction done. Speech was assessed using the London speech evaluation scale (LSES), Performance Status Scale for Head & neck (PSSHN) Speech, and Speech Handicap Index (SHI). Swallowing was assessed with Functional Oral Intake Scale (FOIS), Water swallow test (WST), PSSHN diet, videofluoroscopy (VFS) and New Zealand Index for Multidisciplinary Evaluation of Swallowing (NZIMES). These assessments were done at baseline, 1 month, at 6 months and 1 year after surgery. Results: Between November 2021 and December 2024, 100 eligible patients were enrolled in the study. The median age of the patients was 45 years. With predominantly male patients. There were 40 T1 & T2 and 60 T3 & T4 OTSCC. Fifty percent of the patients were clinico-radiologically N+ disease. All patients underwent surgery with appropriate reconstruction and adjuvant treatment (n=77,77%). We utilised the tongue defect classification proposed by Bhattacarya S et al, of which 18 patients had type 1 defect, 32 patients had type 2 defect, 9 patients type 3 defect and 41 had type 4 defect. Primary closure was done in 23 patients, Local flaps in 19 patients, free flaps in 28 patients and pectoralis major myocutaneous/myofascial flap (PMMC/PMMF). There were no difference in the baseline functional outcomes except for the restriction in the range of tongue movements in cT3 & cT4 OTSCC. In patients with cT1 & cT2 and cT3 & cT4 OTSCC there was no difference in most of the functional assessment parameters throughout the follow up period with respect to the type of reconstruction done. There was a difference in the SHI from baseline to 1st follow up (p=0.039) and 3rd follow-up (p=0.041) in patients with class 1 & 2 defect. There was a similar difference in patients with class 3 & 4 defects at 1st (p=0.016) and 3rd follow up visit (0.041) compared to baseline. There was no major swallowing differences observed on VFS (NZIMES) in patients with class 1 & 2 defect. However, there was a significant difference in patients with class 3 & 4 defect. Conclusions: In this study, we have witnessed no major differences in the functional outcomes with the kind of flap used for various defects. The functional issue seem to be more associated with the defects (reflecting on the extent of resection) more rather than the type of reconstruction done. Clinical trial information: CTRI/2020/01/023080 .