The comparison of the functional outcomes between primary closure and reconstruction with free flap after resection of T1 stage tongue cancer: A prospective study

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background:</jats:bold> Reconstruction with free flap after the resection of tongue cancer is commonly used by craniofacial surgeons. However, it is unknown whether the reconstruction with free flap is better than the primary closure for the T1 stage tongue cancer. The objective of this prospective study is to compare the functional outcomes between these two methods.<jats:bold>Methods:</jats:bold> In this prospective study, 30 patients who were diagnosed as T1 stage tongue cancer (on anterior -two third of the tongue) were randomly divided into two groups. The first group underwent the primary closure after the resection (15 patients) and the second group were reconstructed with the anterolateral perforator flap (15 patients). All patients underwent postoperative functional evaluation using specific questionnaires and a screening test with special emphasis on speech, swallowing, and tongue mobility at 1, 3, 6 and 12 months.<jats:bold>Results:</jats:bold> Functional outcomes, including tongue mobility, speech, and swallowing, were all better in primary closure than anterolateral thigh flap group. At 1-month post-op, the speech understandability of the patients who received a primary closure were statistically better than those who received ALT flap (<jats:italic>p </jats:italic>= 0.01), while at 1-year post-op, there was no significantly different on speech understandability between two groups (<jats:italic>p</jats:italic> = 0.16). Statistically significant differences were found between the two groups in the swallowing capacity at all four different time periods (<jats:italic>p</jats:italic> &lt; 0.05). For the primary closure group, tongue mobility was statistically better at all four different time periods than in ALT flap group (<jats:italic>p</jats:italic> &lt; 0.05).<jats:bold>Conclusion:</jats:bold> For the tongue cancer patients (T1), reconstruction with primary closure, rather than with flap, can reserve more functions including tongue mobility, speech and swallowing outcomes, and therefore might be the appropriate reconstruction method after partial glossectomy.</jats:p>