Effect of Reconstructed Oropharyngeal Conduit Volume on Functional Outcomes
SAHIL K. KAPUR, MD, Baher A. Elgohari, MD, Jun Liu, PhD, Katherine A. Hutcheson, PhD, Clifton D. Fuller, MD, PhD, Peirong Yu, MD, FACS.
MD ANDERSON CANCER CENTER, HOUSTON, TX, USA.
PURPOSE: The volume of the reconstructed oropharynx can vary based on the thickness of free flap used. There exists a knowledge gap in the literature with regard to the impact of free flap thickness (effective oropharyngeal volume) on speech and swallow function. METHODS: A retrospective review of patients undergoing free flap oropharyngeal reconstruction from 2000-2015 was performed. Only defects of the oropharynx (lateral pharyngeal wall, base of tongue and tonsil) were included. Oropharyngeal volume calculated from CT scan was used as a more clinically-relevant marker than flap thickness. Speech and swallow function data were obtained for similar time points. Patients were evaluated within 6 months postoperatively. RESULTS: We analyzed 44 patients, of which 21 were noted to have aspiration. On average patients without aspiration had decreased postoperative oropharyngeal conduit volume of 2.7% compared to baseline, while patients with aspiration had a postoperative volume of 12.7% greater than baseline. Univariate analysis demonstrated that patients with conduit volumes larger than preoperative baseline had a higher probability of aspiration compared to patients with smaller conduit volumes (63% vs. 32% p=0.038). In multivariate analysis, after adjusting for preoperative radiotherapy, we find that larger conduit volumes are associated with a higher risk of aspiration. (p=0.014, adjusted OR=6.55, 95% CI: 1.46-29.39). With regard to speech understandability, however, patients with larger conduit volumes tended to have better speech understandability but the difference was not significant (p=0.166) CONCLUSIONS: Narrower oropharyngeal conduits, reconstructed with thicker flaps demonstrate superior swallow function with respect to aspiration compared to wider conduits.
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