Long-term Functional Outcomes of Total Glossectomy With or Without Total Laryngectomy

IMPORTANCE The optimal reconstruction of total glossectomy defects with or without total laryngectomy is controversial. Various pedicled and free tissue flaps have been advocated, but long-term data on functional outcomes are not available to date. OBJECTIVES To compare various total glossectomy defect reconstructive techniques used by multiple institutions and to identify factors that may lead to improved long-term speech and swallowing function. DESIGN, SETTING, AND PARTICIPANTS A multi-institutional, retrospective review of electronic medical records of patients undergoing total glossectomy at 8 participating institutions between June 1, 2001, and June 30, 2011, who had a minimal survival of 2 years. INTERVENTION Total glossectomy with or without total laryngectomy. MAIN OUTCOMES AND MEASURES Demographic and surgical factors were compiled and correlated with speech and swallowing outcomes. RESULTS At the time of the last follow-up, 45%(25 of 55) of patients did not have a gastrostomy tube, and 76%(42 of 55) retained the ability to verbally communicate. Overall, 75%(41 of 55) of patients were tolerating at least minimal nutritional oral intake. Feeding tube dependence was not associated with laryngeal preservation or the reconstructive techniques used, including flap suspension, flap innervation, or type of flap used. Laryngeal preservation was associated with favorable speech outcomes, such as the retained ability to verbally communicate in 97% of those not undergoing total laryngectomy (35 of 36 patients) vs 44%(7 of 16) in those undergoing total laryngectomy (P <.001), as well as those not undergoing total laryngectomy achieving some or all intelligible speech in 85%(29 of 34 patients) compared with 31% (4 of 13) undergoing total laryngectomy achieving the same intelligibility (P <.001). CONCLUSIONS AND RELEVANCE In patients with total glossectomy, feeding tube dependence was not associated with laryngeal preservation or the reconstructive technique, including flap innervation and type of flap used. Laryngeal preservation was associated with favorable speech outcomes such as the retained ability to verbally communicate and higher levels of speech intelligibility.