Reconstruction de la langue mobile après exérèse carcinologique. Evaluation de la qualité de vie dans 19 cas.

INTRODUCTION: Tumor tongue excision leads to anatomical and functional defects (chewing, swallowing, oral and prosthetic hygiene). The extension of the resection depends on tumor size and surgical radicality. MATERIAL AND METHOD: In our department, 72 cases of lingual tumor were treated between may 1987 and January 1997. 73% of these cases were infiltrating squamous cell carcinomas. 71% were male. Most of the tumors were located at the ventral (45%) and lateral side (36%). 25% of the tumors crossed the midline. Staging was most often pT(2) (46%) and pN(0) (62%). Reconstruction with radial free flap occurred in 37%, with pedicled pectoralis major muscle flap in 13% and with pedicled latissimus dorsi muscle flap in 25% of cases. 51% of the patients were irradiated. All the patients were asked about their quality of live by an 11 questions questionnaire. The questions concerned the different oral and lingual functions and the social, familial, affective and professional life. RESULTS: 19 patients (that means 26%) answered the questionnaire. 9 of them were reconstructed with a flap (6 free radial flaps, 2 pedicled pectoralis major flaps, 1 pedicled latissimus dorsi flap) and were irradiated. In the 10 other patients wounds were closed by simple sutures of the margins. 1 of these 10 patients was irradiated. There was no correlation between scores of the questions and neither pT nor age of patients. We observed a parallelism between scores of the questions about speech and swallowing. Scores of the questions about swallowing were higher when a flap was used for reconstruction, whatever was the type of flap. DISCUSSION: A questionnaire was drawn up from the UW QOL questionnaire. It was a simplified questionnaire with reduced number of questions and simple words. Lesser tongue immobility leads to a better swallowing. Swallowing and speech were worst when tongue resection was large. In this quality of life study, there was a few number of patients that answered the questionnaire so that it is impossible to make a difference between the different flaps.