(0650) Free Flap Neurotization and Radial Forearm Free Flap Reconstruction Improves Functional Outcomes in Hemiglossectomy Defects

Introduction: The aim of this study was to assess the effect of neurotization and free flap choice on functional outcomes for patients undergoing reconstruction of subtotal hemiglossectomy and total hemiglossectomy defects.

Methods: A cross-sectional retrospective study of patients with oral cavity squamous cell carcinoma that underwent a subtotal hemiglossectomy or total hemiglossectomy with free flap reconstruction was conducted. Functional outcomes were evaluated using the University of Washington Quality of Life (UW-QOL) survey and Eating Assessment Tool (EAT-10) greater than 6 months postoperatively.

Results: In total, 33 patients were included in the analysis, and 7 patients had neurotized free flaps. The majority of patients underwent radiation therapy (82%) and underwent anterolateral thigh (ALT) free flap reconstruction (58%). No significant differences in clinicodemographics were noted between neurotized and non-neurotized patients. Neurotized patients were noted to have increased range of swallowing (p = 0.02), increased range of chewing (p = 0.03), and decreased effort in swallowing liquids (p = 0.04). Patients that underwent ALT free flap reconstruction had worse understandability of speech compared to radial forearm free flap reconstruction, controlling for type of glossectomy defect (p = 0.04).

Conclusions: Free flap neurotization for reconstruction of subtotal hemiglossectomy and total hemiglossectomy defects resulted in better swallowing and chewing range and less liquid swallowing effort. In this small series, ALT free flaps had worse speech outcomes compared to radial forearm free flaps.