Swallowing Function before and after Subtotal Glossectomy and Reconstruction with a Rectus Abdominis Musculocutaneous Flap: A Case Report

Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materials and Methods: A 41-year-old man underwent subtotal glossectomy and retained the unilateral posterior mylohyoid and unilateral stylohyoid muscles. The structure of the flap was evaluated postoperatively. To assess swallowing function, video fluorography was performed before surgery, 1 month after surgery and 1 year after surgery. Testing involved 1) ability to hold 10 mL of liquid in the oral cavity, 2) epiglottis turnover, 3) the presence of aspiration, 4) hyoid bone movement, and 5) maximum width of the esophageal entrance. Results: The flap was protuberant postoperatively. The patient was able to hold the test diet in the oral cavity before and after surgery. Epiglottis turnover was good before surgery but insufficient after surgery. Aspiration during swallowing was not observed before or after surgery. At rest, the hyoid bone sagged postoperatively, in comparison with preoperatively. Hyoid bone movement and width of the esophageal entrance decreased after surgery;however, they demonstrated gradual recovery. Conclusions: For good postoperative swallowing function after subtotal glossectomy, it is necessary to perform reconstruction with protuberant flap and to retain the suprahyoid muscles as much as possible.

Immunomodulatory extracellular matrix hydrogel induces tissue regeneration in a model of partial glossectomy

While oropharyngeal cancer treatment regimens,including surgical resection,irradiation,and chemotherapy,are effective at removing tumors,they lead to muscle atrophy,denervation,and fibrosis,contributing to the pathogenesis of oropharyngeal dysphagia-difficulty swallowing.Current standard of care of rehabilitative tongue strengthening and swallowing exercises is ineffective.Here,we evaluate an alternative approach utilizing an acellular and injectable biomaterial to preserve muscle content and reduce fibrosis of the tongue after injury.Skeletal muscle extracellular matrix(SKM)hydrogel is fabricated from decellularized porcine skeletal muscle tissue.A partial glossectomy injury in the rat is used to induce tongue fibrosis,and SKM hydrogels along with saline controls are injected into the site of scarring two weeks after injury.Tissues are harvested at 3 and 7 days post-injection for gene expression and immunohistochemical analyses,and at 4 weeks post-injection to evaluate histomorphological properties.SKM hydrogel reduces scar formation and improves muscle regeneration at the site of injury compared to saline.SKM additionally modulates the immune response towards an anti-inflammatory phenotype.This study demonstrates the immunomodulatory and tissue-regenerative capacity of an acellular and minimally invasive ECM hydrogel in a rodent model of tongue injury.

Transoral robotic surgery vs.endoscopic partial midline glossectomy for obstructive sleep apnea

Objective:To compare sleep-related outcomes in obstructive sleep apnea hypopnea syndrome (OSAHS) patients following base of tongue resection via robotic surgery and endoscopic midline glossectomy.Methods:This was a retrospective study.A total of 114 robotic and 37 endoscopic midline glossectomy surgeries were performed between July 2010 and April 2015 as part of single or multilevel surgery.Patients were excluded for indications other than sleep apnea or if complete sleep studies were not obtained.Thus,45 robotic and 16 endoscopic surgeries were included in the analysis.Results:In the robotic surgery group there were statistically significant improvements in AHI [(44.4 ± 22.6) events/h-(14.0 ± 3.0) events/h,P ＜ 0.001] Epworth Sleepiness Scale (12.3 ± 4.6 to 4.5 ± 2.9,P ＜ 0.001),and O2 nadir (82.0％ ± 6.1％ to 85.0％ ± 5.4％,P ＜ 0.001).In the endoscopic group there were also improvements in AHI (48.7 ± 30.2 to 27.4 ± 31.9,P =0.06),Epworth Sleepiness Scale (12.6 ± 5.5 to 8.3 ± 4.5,P =0.08),and O2 nadir (80.2％ ± 8.6％ to 82.7％ ± 6.5％,P =0.4).Surgical success rate was 75.6％ and 56.3％ in the robotic and endoscopic groups,respectively.Greater volume of tissue removed was predictive of surgical success in the robotic cases (10.3 vs.8.6 ml,P =0.02).Conclusions:Both robotic surgery and endoscopic techniques for tongue base reduction improve objective measures of sleep apnea.Greater success rates may be achieved with robotic surgery compared to traditional methods.

Excision margins in squamous cell carcinoma of the tongue: A retrospective audit and review of the literature

The incidence of close and involved tongue resection margins for squamous cell carcinoma (SCC) were reviewed with the aim to identify any possible need for change in the surgical approach to glossectomies. The histopathological reports of 101 partial glossectomies for SCC between 2006 and 2012 were retrospectively reviewed. Results: Overall 52 (51.5%) patients had one or more close or involved margin and 9 (8.9%) had both close and involved margins. 42 (41.5%) patients had close margins and 11 (10.9%) had involved margins. The inferior/lateral muscoal margin was most frequently close/involved (32%) followed by deep margin (27%). The anterior margin was least close/involved (5%). The posterior and superior/medical margins were close/involved in 12% and 11% of cases respectively. Conclusions: 52.5% of patients had close or involved margins following surgery, potentially requiring further treatment to avoid an increased risk of tumour recurrence and the associated increase in morbidity and mortality. The inferior/lateral and deep margins were most frequently involved possible due to the anatomical difficulties visualising and dissecting these margins. The potential explanations for these disparities and possible solutions are discussed.

Transoral robotic surgery for obstructive sleep apnea syndrome: Principles and technique

Objective:The present study is a review of transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS).Methods:The review presents the experience of the robotic center that developed the technique with regards to patient selection,surgical method,and post-operative care.In addition,the review provides results of a systematic review and meta-analysis of the complications and clinical outcomes of TORS when applied in the management of OSAHS.Results:The rate of success,defined as 50％ reduction of pre-operative AHI and an overall AHI ＜20 events/h,is achieved in up to 76.6％ of patients with a range between 53.8％ and 83.3％.The safety of this approach is reasonable as the main complication (bleeding) affected 4.2％ of patients (range 4.2％-5.3％).However,transient dysphagia (7.2％;range 5％-14％) does compromise the quality of life and must be discussed with patients preoperatively.Conclusions:TORS for the treatment of OSAHS appears to be a promising and safe procedure for patients seeking an alternative to traditional therapy.Appropriate patient selection remains an important consideration for successful implementation of this novel surgical approach requiring further research.