Evaluation Of Mid-and Long-term Efficacy Of Functional Tongue Reconstruction With Anterolateral Thigh Flap After Tongue Cancer Resection

ObjectiveTo compared the sensation,function recovery and the quality of life（QOL）of patients reconstructed with innervated ALTF and noninnervated ALTF after 6 months of surgery.To explore the med-and long-term efficacy of functional tongue reconstruction with ALTF after locally advanced tongue cancer surgery.MethodsThe study included 75 patients with locally advanced tongue cancer(T_3-4N_0-3M₀)whom underwent radical tongue cancer resection.The test group underwent functional tongue reconstruction with sensory and motor nerves VLTF,and the control group underwent non-functional tongue reconstruction with noninervated VLTF.1.Tongue cancer resection:After general anesthesia,the primary tumor was removed1.5～2cm from the edge of the tumor,and dissection the mucosa,muscle,and sublingual gland at the affected side of the mouth simultaneously.Neck lymph node dissection was performed according to the status of lymph node.2.Preparation of ALTF:The body surface of perforating artery of anterolateral thigh was located by ultrasound Doppler.The flap was designed according to the perforator artery and the size of the oral defect,and the lateral femoral cutaneous nerve and motor nerve branches were preserved in the test group.3.Reconstruction:Flap vessels were anastomosed with the receptor vessels under microscope.The flap was anastomosed with the floor of the mouth,the residual tongue and the buccal muscle,respectively,and reshaped the tongue.In the test group,the sensory never and the motor nerve were repaired with the receptor lingual nerve and the hypoglossal nerve in the receiving area,respectively.4.Follow-up:The flaps were monitored closely.Made an appointment with patients to be rechecked every 3 months,and statistical analysis of survival results of patients.5.Testing and evaluation:The sensation（two-point discrimination,temperature and pain）and functions（movement,swallowing,speech,chewing）recovery of the neotongue were evaluated every 3 months half a year after surgery,the types of dysphagia were evaluated by VFSS.The QOL of patients was evaluated by UW-QOL.Results1.Total of 75 patients,necrotic flap in 2 cases were replaced by the pectoralis major muscle flap,with a flap survival rate of 97.3%.The median follow-up time was 37months（12～72 months）,excluding necrotic flaps,3 lost cases and 2 cases of undetected patients,68 patients were included in the survival analysis,which include 34 patients in each of the test group and in the control group.The overall survival rate was 51.5%,of which the test group was 52.9%and the control group was 50.0%（P=0.999）.2.There were 68,41,and 24 patients who completed sensation and function tests at6,12,and 24 months,respectively.Sensation results:After 6 months postoperative,the two-point discrimination and cold temperature recovery of the test group were more sensitive than the control group（P<0.05）,but there was no significant difference in pain sensation and heat temperature（P>0.05）;In the 12 and 24 months postoperative,all sensation in the test group was significantly better than those in the control group（P<0.05）.Function results:The patients obtained relatively good function results after reconstruction.Among them,the swallowing function was significantly better than the control group at 6,12 and 24 months after surgery（P<0.05）,but it was not found in movement,speech,and chewing function（P>0.05）.3.25 patients completed the VFSS detection.The results showed that the tongue loss control during bolus hold,oral residue,delayed pharyngeal swallowing,base of tongue retraction,and pharyngeal residue were common types of dysphagia.Compared with the test group,the initiation of swallowing of the control group was significantly slower（P=0.027）,and the oral transit time（P=0.026）was longer.however,the pharyngeal transit time was not statistically different between the two groups（P=0.668）.4.Quality of life:Chewing,taste,saliva,and anxiety problems were prominent at 6months after surgery,which improved at 12 and 24 months postoperative,and saliva score was always low.At 6,12,and 24 months after surgery,the total score of quality of life in the test group was significantly higher than that in the control group（P<0.05）.Conclusion1.The ALTF flap could be used as an ideal flap for locally advanced tongue cancer postoperative reconstruction because of high flap survival rate,and few complications.2.The ALTF functional tongue reconstruction with sensory nerve and motor nerve reconstruction could better restore the sensation of the neotongue,which was helpful to improve the mid-and long-term swallowing function and quality of life of patients with locally advanced tongue cancer.The motor functions of the reconstructed tongue need further observation.