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Assessment of Quality of Life of Free Anterolateral Thigh Flap for Reconstruction of Tissue Defects of Total or Near-Total Glossectomy

Assessment of Quality of Life of Free Anterolateral Thigh Flap for Reconstruction of Tissue... Hindawi Journal of Oncology Volume 2020, Article ID 2920418, 5 pages https://doi.org/10.1155/2020/2920418 Research Article AssessmentofQualityofLifeofFreeAnterolateralThighFlapfor Reconstruction of Tissue Defects of Total or Near-Total Glossectomy Sanke Zhang, Shuang Wu, Lei Liu, Dandan Zhu, Qiuyu Zhu, and Wenlu Li Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China Correspondence should be addressed to Wenlu Li; lwldoctor@163.com Received 21 September 2019; Revised 26 December 2019; Accepted 28 January 2020; Published 10 October 2020 Guest Editor: Qigen Fang Copyright © 2020 Sanke Zhang et al. /is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. /e aim of this study was to evaluate quality of life of free anterolateral thigh flap (ALTFF) for reconstruction of tissue defects of total or near-total glossectomy. Methods. Quality of life was assessed by means of the University of Washington Quality of Life (UW-QOL) and the 14-item Oral Health Impact Profile (OHIP-14), after 12 months post- operatively. Results. 65 of 79 questionnaires were returned (82.27%). In the UW-QOL, the best-scoring domain was “shoulder,” whereas the lowest scores were for “chewing” and “pain.” In the OHIP-14, the lowest-scoring domain was “handicap,” followed by “Social disability” and “Psychological disability.” Conclusion. Free anterolateral thigh perforator flaps for reconstruction of total or near-total glossectomy defects after cancer resection would have significantly influenced the patients’ oral functions and quality of life. operations for oral cancer. /e free anterolateral thigh 1.Introduction perforator flaps first reported by Song [4] in 1984 has Tongue cancer is one of the common malignant tumors gained popularity in oral cavity reconstructions. It has in the oral and maxillofacial region. Although the current some advantages, including a long pedicle with a suitable treatment presents multiple modes, the prognosis of vessel diameter, the availability of different tissues with tongue cancer is not good, and the dominant and hidden large amounts of skin, and its adaptability as a sensate or lymph node metastasis is also more obvious than other flow-through flap if necessary [5, 6]. oral malignant tumors. /e 5-year survival rate of Quality of life (QOL) is multidimensional and reflects comprehensive treatment of tongue squamous cell car- the patient’s point of view, whereas quality of life research cinoma in foreign countries is 50%–70% [1–3]. reflects the effect of the disease and its treatment on general /e reconstruction of defects after resection of oral wellbeing. QOL has become an increasingly important cancer is a challenge because of the critical role of this area outcome measure for patient’s undergoing treatment for a both aesthetically and functionally. Radical resection af- wide array of illnesses. QOL is a global construct that reflects fects all oral functions and can result in subsequent a patient’s general sense of wellbeing. It is by definition problems. Depending on the location and size of the multidimensional and reflective of the patient’s point of view tongue tumor, radical surgical treatment often affects all [7]. /e aim of this study was to evaluate quality of life of free oral functions, such as speech, swallowing, chewing, oral anterolateral thigh flap for reconstruction of tissue defects of rehabilitation, nutrition, and appearance [1]. Now, total or near-total glossectomy. /ese findings could po- transfer of free flaps with microvascular anastomoses is tentially be useful for physicians and patients, while treat- the favored method of reconstruction after major ment is being planned. 2 Journal of Oncology Table 1: Patients’ demographic and TNM/clinical stages (n � 65). 2.Materials and Methods Patients’ demographic and stages Number of cases (%) Because this study was retrospective, it was granted an Male 56 86.2 exemption in writing by the Ethical Review Board in the Age< 65Y 47 72.3 First Affiliated Hospital of Zhengzhou University. From Karnofsky score <70 43 66.2 April 2010 through April 2018, a total of 79 patients at the Primary tumor Department of Oral and Maxillofacial Surgery, the First T1 4 6.2 Affiliated Hospital of Zhengzhou University, underwent free T2 8 12.3 anterolateral thigh perforator flaps reconstruction after T3 31 47.8 radical surgery for total and near-total tongue cancer was T4 22 33.8 Regional lymph nodes studied retrospectively. It was granted an exemption in N0 27 41.5 writing by the Ethical Review Board of the Zhengzhou NI 12 18.5 University and the First Affiliated Hospital of Zhengzhou N2a 8 12.3 University. N2b 9 13.8 /ere were 56 males and 23 females, aged 25–70 years N2c 6 9.2 old, with a median age of 49 years. /e case data were N3 3 4.6 collated, recorded, and retrospectively analyzed to record the Distant metastasis primary disease, tongue defect, tissue flap type, and post- M0 61 93.8 operative complications. Case inclusion criteria were ad- M1 4 6.2 vanced tongue or mouth cancer, complete or near-total Clinical stages tongue defect after tumor resection, and free tissue flap to I 3 4.6 repair tongue defect at the same time. /e total tongue defect II 10 15.4 III 29 44.6 refers to the defect of the tongue and tongue root tissue, and IV (IVaIVbIVc) 23 35.4 the proximal tongue defect includes 2/3 in front of the Pathologic diagnosis tongue or most of the tongue (2/3 or more). Other inclusion Squamous cell carcinoma 56 86.2 criteria were free flap survived completely; age less than 75 Other carcinoma 9 13.8 years; no previous or synchronous malignancies; no cog- nitive impairment; at least 12 months after reconstruction; and patients with recurrence of the disease. saliva, mood, and anxiety), and 3 are global questions. /e remaining patients received a formal letter Each of the 12 questions included has 3–6 choices of explaining the study, an informed consent form, and the response. /e domains are scored on a scale ranging from University of Washington quality of life (UW-QoL)/the 14- 0 (worst) to 100 (best). /e standard UW-QoL is available item Oral Health Impact Profile (OHIP-14). /ose patients in Chinese and has been validated for a Chinese pop- who did not reply within one month received a reminder. ulation [8] according to the methods of our past research Patients who were not able to fill in the questionnaires [9]. themselves, e.g., due to dementia or language were excluded from the study. Patient characteristics are summarized in 3.Results Table 1. 3.1. Patient Characteristics. /e patients’ demographic and TNM/clinical stages are listed in Table 1. Of the 65 patients 2.1. Questionnaires and Data Collection. Although many who completed questionnaires, patients were staged generic QOL instruments have been developed over the according to the 2010 American Joint Committee on Cancer past 30 years, the University of Washington quality of life (AJCC) staging system; their main clinical characteristics are (UW-QoL) [8] and OHIP-14 consists of 14 items divided listed in Table 1. In our research, more than half our patients into 7 domains: functional limitation, physical pain, had had little education, 18 patients could not read or write psychological discomfort, physical disability, psycholog- and needed help to complete the questionnaire, 5 patients ical disability, social disability, and handicap. Each item is were orphans, and 7 patients lived alone. scored as 0 � never; 1 � hardly ever; 2 � sometimes; But even in this, 65 of the 79 questionnaires (82.27%) 3 � fairly often; and 4 � very often. /e domains are scored were completed, SF-36 and OHIP-14, at one or two time on a scale ranging from 0 (best) to 100 (worst). /e higher points during the treatment and follow-up periods. /e time the score, the poorer the patient’s state of health. /e needed for completing both questionnaires is very accept- standard OHIP-14 is available in Chinese and has been able and makes it feasible to use them in clinical studies. validated for a Chinese population [8]. /e UW-QoL scale Data for the SF-36 and OHIP-14 scales at 12 months after is filled in by the patient and provides a broad measure of TFFF are shown in Tables 2 and 3. In TNM stages research QoL for patients with head and neck cancer with good studies, we found that most patients had T3-T4 stage tumors acceptability, practicality, validity, reliability, and re- and only a few T1 and T2 stages. /is may be because sponsiveness. /e questionnaire is composed of 15 do- patients with T1-T2 stage tumors had small tumors that did mains: 12 are disease-specific (pain, appearance, activity, not need AFFF reconstruction. recreation, swallowing, chewing, speech, shoulder, taste, Journal of Oncology 3 Table 2: Means of scores of items and scales of University of vascular pedicle, and contour ability and maintains con- Washington Quality of Life questionnaire. sistent volume and surface area over it. AFFF helped to shift focus away from simple coverage of defects towards mini- Number of cases (n � 65) mizing morbidity at the donor site, refining the flap, Domain Mean Median Percentage with score selecting the most appropriate donor tissue, reducing bulk, (SD) (range) 80+ and reconstructing defects in a functional, three-dimen- Pain 42.7 (4.5) 43 (20–65) 0 sional manner, and it was recognized as the method of Appearance 56.8 (5.4) 58 (40–82) 4 choice for reconstruction of soft tissue defects in the oral Activity 65.3 (10.7) 66 (35–86) 9 cavity and oropharynx, especially in tongue cancer. Recreation 56.1 (6.2) 57 (30–70) 0 For patients with total and near-total glossectomy, oral Swallowing 43.8 (9.3) 44 (15–66) 0 feeding and speech function are largely dependent on flap Chewing 41.2 (13.2) 42 (10–65) 0 Speech 53.2 (6.4) 54 (0–70) 0 reconstruction to restore tongue morphology and dynamic Shoulder 78.6 (11.3) 79 (60–88) 15 function. Kimata et al. [14] divided the shape of the Taste 65.4 (7.5) 66 (10–75) 0 reconstructed tongue into the oral cavity into four types: Saliva 61.2 (8.5) 63 (30–85) 8 bulge type, semi-uplift type, flat type, and concave type. Mood 61.9 (7.9) 62 (40–75) 0 Among them, the bulging type and the semi-uplift type are Anxiety 70.5 (6.7) 71 (45–86) 12 basically in contact with the upper jaw when the mouth is closed, and the gap between the oropharynx is narrow, 3.2. UW-QOL. /e scores for the 12 disease-specific do- which is conducive to the recovery of eating and language function. In order to the reconstructed tongue to reach a mains and the importance of each domain are shown in Table 2. At the top of the list of high-scoring domains were bulge and a semiembossed configuration, the repaired tissue shoulder and anxiety. 15 patients scored 80% or more for is required to have a sufficient and relatively constant vol- anxiety (mean (SD) 70.5 (6.7) points). /e best-scoring ume. /erefore, the key point of functional recovery after domain was shoulder, with a mean (SD) score of 78.6 (11.3) total tongue and near-total tongue reconstruction is the amount of flap tissue. /e free anterolateral thigh flap can points. /e worst score was for chewing, with a mean (SD) score of 41.2 (13.2) points. All patients were dissatisfied with provide a large amount of soft tissue and can carry part of muscle tissue, which is beneficial to recovery of oral function chewing, speech, recreation, and pain. In the selection of the most important of the 3 domains, chewing was considered in postoperative patients. In the assessment of any therapy, particularly for cancer most important, followed by speech and swallowing. /e domains pain, swallowing, and taste were the least important patients, analysis of QOL represents the ultimate step of the evaluation process. QOL has recently become a constant to patients. preoccupation in the assessment of any therapy in oncology. Some authors describe QOL as welfare state along with 3.3. OHIP-14. Distributions of OHIP-14 domain scores at patient’s satisfaction. Other authors relate QOL as the dif- presentation are shown in Table 3. /e best mean (SD) ference between the patient’s expectations and what they can domain scores for the complete group were 30.2 (5.6) for really perceive. Assessment of QOL can now be used in an handicap, 43.8 (8.7) for psychological disability, and 45.2 attempt to improve treatment outcomes, and to measure (11.2) for social disability. /e highest scores were for success or failure in cancer treatment has been survival, psychological disability and physical pain. understood as a period free of disease. Completion of questionnaires can help put into context what other patients report as their outcome after intervention allowing greater 4.Discussion patient-doctor interactions and understanding. It also allows Oral cancer is one of the most common malignant tumors in expressions of concern that the patient is otherwise reluctant the body. /e incidence of tongue cancer in oral cancer is the to mention. Nevertheless, few studies have assessed QOL in highest. Recent studies at home and abroad have shown that our field of interest. In our study, we used the UW-QOL and the incidence of oral cancer is on the rise in the world [10], OHIP-14 questionnaires to assess the postoperative QOL of these patients and the possible relation to surgery. and the age of the disease tends to be younger [11]. Tongue cancer has the characteristics of high malignancy, high local /e UW-QOL measure was chosen as the oral-specific questionnaire that provided a broad measure of QOL for recurrence rate, high cervical lymph node metastasis rate, and often endangers patients’ lives. /erefore, the best patients with tongue cancer with good acceptability, practi- cality, validity, reliability, and responsiveness. Language is choice is surgical radicalization. At present, most of the surgery is based on comprehensive treatment [12]. At simple, but because individual response options are provided present, it is generally acknowledged that free flaps transfer for each question rather than using a standardized scale, the with microvascular anastomosis is the favored method for reading burden is high. Each item is scored from 0 to 100, with reconstruction after major oral cancer surgery [13]. Yang higher scores indicating better QOL, resulting in a summary score of 0–900 for the disease-specific items, and each question et al. first made the radial free forearm flap (RFFF) in 1981, which was a major breakthrough in reconstructive surgery has 3–6 response options. It is brief and appropriate, so it can be used on a regular basis with low cost. It presents an ad- and appreciated in this type of reconstruction. It is a free tissue transfer characterized by thinness, pliability, a long ditional module, which evaluates emotional status and anxiety. 4 Journal of Oncology Table 3: Means of scores of items and scales of Oral Health Impact Profile-14 questionnaire. Number of cases (n � 65) Domain Mean (SD) Median (range) Score 40 or fewer (%) Functional limitation 52.3 (4.5) 53 (20–66) 11 Physical pain 55.3 (5.4) 56 (15–82) 14 Psychological discomfort 51.7 (10.1) 53 (20–73) 18 Physical disability 71.2 (9.2) 72 (30–80) 8 Psychological disability 43.8 (8.7) 44 (15–66) 36 Social disability 45.2 (11.2) 46 (10–60) 22 Handicap 30.2 (5.6) 30 (0–45) 55 In our study, many authors have chosen to use the UW-QOL patients in a more advanced stage. /e cervical dissection questionnaire [8], and the highest score in the UW-QOL along with the scar consequence of the surgical recon- subscales was in the domain shoulder. /e mean (SD) score struction with a myocutaneous pediculed flap is a combi- was 78.6 (11.3), which indicated slight damage in the shoulder nation that in a most important way influences in patient’s complaints on esthetic and pain in the reconstructed lo- domain. As well as shoulder and patients scored high for anxiety (70.5 (6.3)) and taste (65.4 (7.5)), which indicates that cation [18]. Little shoulder dysfunction has been reported with unilateral selective neck dissections (level I–III/IV) as the operation, had little effect on the functions of taste and anxiety. As well as the domain of pain, chewing, and swal- compared with no dissection. During our study, significantly lowing were lower than others because of tongue cancer worse shoulder function was also found if selective neck characteristics, patients reluctant to communicate with other, dissections were bilateral or extended to level V. especially when sharp stimulus contained sharp teeth or /ere were limitations that could influence the result of dentures around primary tumor in our study. our findings. We described oral cancer in the study pop- We used the Chinese version of the OHIP-14, which has ulation at one point in time, and so could not fully assess its been translated and validated for use in Hong Kong and impact on patients’ QOL over the whole postoperative China [15]. /e best mean (SD) domain scores for the period. Under these circumstances, QOL assessment is quite a new area, and the emphasis is placed on clinical practice complete group were 30.2 (5.6) for handicap, 43.8 (8.7) for psychological disability, and 45.2 (11.2) for social disability. and research. Considerable effort should therefore be put into it. QOL should be acknowledged as an important /e highest score was for physical disability (71.2 (9.2)), and no patients scored 40%. For the physical disability questions, outcome, together with traditional biomedical outcomes. we asked “Has your diet been satisfactory because of your teeth, mouth, or dentures?” and “Have you had to interrupt 5.Conclusion meals because of your teeth, mouth, or dentures?” No pa- In total and near-total tongue cancer postoperative free flap tient was satisfied with the degree of physical disability. Loss for reconstruction, QQL assessment is quite a new area, and of teeth greatly weakened the patients’ oral function. the emphasis is placed on clinical practice and research. Total tongue resection and the extent of local lesion /erefore, considerable effort should be paid to this area. resection are large; patients with malignant tumors need to QQL should be acknowledged as an important outcome undergo unilateral or bilateral neck dissection, and free flap parameter, along with the traditional biomedical outcomes. transplantation at the same time has the problems of Clinically, QQL should be used as a part of tongue cancer complicated operation, large trauma, and long duration. In treatment, and this should be considered for surgical addition, such patients usually require tracheotomy, and the planning. ALTFF for reconstruction of defects of tongue possibility of postoperative pulmonary infection is high. At significantly influenced QOL. the same time, due to poor tongue swallowing function, the possibility of aspiration after surgery is also high, resulting in Data Availability inhalation pneumonia, leading to a series of postoperative complications. Moreover, patients with postoperative head /e data used to support the findings of this study are in- brakes need to rest in bed for a long time, which is easy to cluded within the article. cause complications for patients with poor cardiopulmonary function. /erefore, the general anesthesia should be used to Conflicts of Interest evaluate the general condition of the patient before surgery, and the preoperative examination should be improved to /e authors declare that there are no conflicts of interest deal with adverse reactions. regarding the publication of this paper. Because of the rich supply of lymph and blood and tongue cancer more prone to lymph node metastasis and Acknowledgments blood metastasis, cervical dissection must be carried out during operation. Worse QOL has been found in patients /is work was supported by the National Natural Science with cervical dissection operation compared to those who Foundation of China-Youth Science Foundation did not have it [16, 17], related to the fact that they are (81402578). Journal of Oncology 5 [16] J. Ringash, A. Bezjak, R. Ratansi, and A. Kanatas, “A struc- References tured review of quality of life instruments for head and neck [1] S.-F. Huang, C.-J. Kang, C.-Y. Lin et al., “Neck treatment of cancer patients,” Head & Neck, vol. 23, no. 3, pp. 201–213, patients with early stage oral tongue cancer,” Cancer, vol. 112, 2001. no. 5, pp. 1066–1075, 2008. [17] S. Laverick, D. Lowe, J. S. Brown, E. D. Vaughan, and [2] A. K. D’cruz, R. C. Siddachari, R. R. Walvekar et al., “Elective S. N. Rogers, “/e impact of neck dissection on health-related neck dissection for the management of the n0 neck in early quality of life,” Archives of Otolaryngology-Head & Neck cancer of the oral tongue: need for a randomized controlled Surgery, vol. 130, no. 2, pp. 149–154, 2004. trial,” Head & Neck, vol. 31, no. 5, pp. 618–624, 2009. [18] S. N. Rogers, D. Lowe, M. Patel, J. S. Brown, and [3] M. Y. Hs and C. C. Wang, “Elective radiotherapy or neck E. D. Vaughan, “Clinical function after primary surgery for dissection for CT-staged T1-2N0 oral tongue cancer,” Head oral and oropharyngealcancer: an 11-item examination,” Neck, vol. 32, no. 2, pp. 191–198, 2010. British Journal of Oral and Maxillofacial Surgery, vol. 40, no. 1, [4] Y.-G. Song, G.-Z. Chen, and Y.-L. Song, “/e free thigh flap: a pp. 1–10, 2002. new free flap concept based on the septocutaneous artery,” British Journal of Plastic Surgery, vol. 37, no. 2, p. 149, 1984. [5] F.-C. Wei, V. Jain, N. Celik, H.-C. Chen, D. C.-C. Chuang, and C.-H. Lin, “Have we found an ideal soft-tissue flap? an ex- perience with 672 anterolateral thigh flaps,” Plastic and Re- constructive Surgery, vol. 109, no. 7, pp. 2219–2226, 2002. [6] W. Li, Z. Xu, F. Liu, S. Huang, W. Dai, and C. Sun, “Vas- cularized free forearm flap versus free anterolateral thigh perforator flaps for reconstruction in patients with head and neck cancer: assessment of quality of life,” Head & Neck, vol. 35, no. 12, pp. 1808–1813, 2013. [7] B. A. Murphy, N. Ridner, M. Wells, and M. Dietrich, “Quality of life research in head and neck cancer: a review of the current state of the science,” Critical Reviews in Oncology/Hematology, vol. 62, no. 3, pp. 251–267, 2007. [8] W. Li, Y. Yang, Z. Xu et al., “Assessment of quality of life of patients with oral cavity cancer who have had defects reconstructed with free anterolateral thigh perforator flaps,” British Journal of Oral and Maxillofacial Surgery, vol. 51, no. 6, pp. 497–501, 2013. [9] J. Zhu, Y. Yang, and W. Li, “Assessment of quality of life and sociocultural aspects in patients with ameloblastoma after immediate mandibular reconstruction with a fibular free flap,” British Journal of Oral and Maxillofacial Surgery, vol. 52, no. 2, pp. 163–167, 2014. [10] Z. Nemeth, ´ A. Somogyi, Z. Takacsi-nagy, ´ J. Barabas, ´ G. Nemeth, ´ and G. Szabo, ´ “Possibilities of preventing osteoradionecrosis during complex therapy of tumors of the oral cavity,” Pathology & Oncology Research, vol. 6, no. 1, pp. 53–58, 2000. [11] J. Wade, H. Smith, M. Hankins, and C. Llewellyn, “Con- ducting oral examinations for cancer in general practice: what are the barriers?” Family Practice, vol. 27, no. 1, pp. 77–84, [12] A. Bleyer, “Cancer of the oral cavity and pharynx in young females: increasing incidence, role of human papilloma virus, and lack of survival improvement,” Seminars in Oncology, vol. 36, no. 5, pp. 451–459, 2009. [13] R. De Bree, A. Rinaldo, E. M. Genden et al., “Modern re- construction techniques for oral and pharyngeal defects after tumor resection,” European Archives of Oto-Rhino-Laryn- gology, vol. 265, no. 1, pp. 1–9, 2008. [14] Y. Kimata, M. Sakuraba, S. Hishinuma et al., “Analysis of the relations between the shape of the reconstructed tongue and postoperative functions after subtotal or total glossectomy,” :e Laryngoscope, vol. 113, no. 5, pp. 905–909, 2003. [15] J. Zheng, M. C. M. Wong, and C. L. K. Lam, “Key factors associated with oral health-related quality of life (OHRQOL) in Hong Kong Chinese adults with orofacial pain,” Journal of Dentistry, vol. 39, no. 8, pp. 564–571, 2011. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Oncology Hindawi Publishing Corporation

Assessment of Quality of Life of Free Anterolateral Thigh Flap for Reconstruction of Tissue Defects of Total or Near-Total Glossectomy

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Copyright © 2020 Sanke Zhang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Journal of Oncology Volume 2020, Article ID 2920418, 5 pages https://doi.org/10.1155/2020/2920418 Research Article AssessmentofQualityofLifeofFreeAnterolateralThighFlapfor Reconstruction of Tissue Defects of Total or Near-Total Glossectomy Sanke Zhang, Shuang Wu, Lei Liu, Dandan Zhu, Qiuyu Zhu, and Wenlu Li Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China Correspondence should be addressed to Wenlu Li; lwldoctor@163.com Received 21 September 2019; Revised 26 December 2019; Accepted 28 January 2020; Published 10 October 2020 Guest Editor: Qigen Fang Copyright © 2020 Sanke Zhang et al. /is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. /e aim of this study was to evaluate quality of life of free anterolateral thigh flap (ALTFF) for reconstruction of tissue defects of total or near-total glossectomy. Methods. Quality of life was assessed by means of the University of Washington Quality of Life (UW-QOL) and the 14-item Oral Health Impact Profile (OHIP-14), after 12 months post- operatively. Results. 65 of 79 questionnaires were returned (82.27%). In the UW-QOL, the best-scoring domain was “shoulder,” whereas the lowest scores were for “chewing” and “pain.” In the OHIP-14, the lowest-scoring domain was “handicap,” followed by “Social disability” and “Psychological disability.” Conclusion. Free anterolateral thigh perforator flaps for reconstruction of total or near-total glossectomy defects after cancer resection would have significantly influenced the patients’ oral functions and quality of life. operations for oral cancer. /e free anterolateral thigh 1.Introduction perforator flaps first reported by Song [4] in 1984 has Tongue cancer is one of the common malignant tumors gained popularity in oral cavity reconstructions. It has in the oral and maxillofacial region. Although the current some advantages, including a long pedicle with a suitable treatment presents multiple modes, the prognosis of vessel diameter, the availability of different tissues with tongue cancer is not good, and the dominant and hidden large amounts of skin, and its adaptability as a sensate or lymph node metastasis is also more obvious than other flow-through flap if necessary [5, 6]. oral malignant tumors. /e 5-year survival rate of Quality of life (QOL) is multidimensional and reflects comprehensive treatment of tongue squamous cell car- the patient’s point of view, whereas quality of life research cinoma in foreign countries is 50%–70% [1–3]. reflects the effect of the disease and its treatment on general /e reconstruction of defects after resection of oral wellbeing. QOL has become an increasingly important cancer is a challenge because of the critical role of this area outcome measure for patient’s undergoing treatment for a both aesthetically and functionally. Radical resection af- wide array of illnesses. QOL is a global construct that reflects fects all oral functions and can result in subsequent a patient’s general sense of wellbeing. It is by definition problems. Depending on the location and size of the multidimensional and reflective of the patient’s point of view tongue tumor, radical surgical treatment often affects all [7]. /e aim of this study was to evaluate quality of life of free oral functions, such as speech, swallowing, chewing, oral anterolateral thigh flap for reconstruction of tissue defects of rehabilitation, nutrition, and appearance [1]. Now, total or near-total glossectomy. /ese findings could po- transfer of free flaps with microvascular anastomoses is tentially be useful for physicians and patients, while treat- the favored method of reconstruction after major ment is being planned. 2 Journal of Oncology Table 1: Patients’ demographic and TNM/clinical stages (n � 65). 2.Materials and Methods Patients’ demographic and stages Number of cases (%) Because this study was retrospective, it was granted an Male 56 86.2 exemption in writing by the Ethical Review Board in the Age< 65Y 47 72.3 First Affiliated Hospital of Zhengzhou University. From Karnofsky score <70 43 66.2 April 2010 through April 2018, a total of 79 patients at the Primary tumor Department of Oral and Maxillofacial Surgery, the First T1 4 6.2 Affiliated Hospital of Zhengzhou University, underwent free T2 8 12.3 anterolateral thigh perforator flaps reconstruction after T3 31 47.8 radical surgery for total and near-total tongue cancer was T4 22 33.8 Regional lymph nodes studied retrospectively. It was granted an exemption in N0 27 41.5 writing by the Ethical Review Board of the Zhengzhou NI 12 18.5 University and the First Affiliated Hospital of Zhengzhou N2a 8 12.3 University. N2b 9 13.8 /ere were 56 males and 23 females, aged 25–70 years N2c 6 9.2 old, with a median age of 49 years. /e case data were N3 3 4.6 collated, recorded, and retrospectively analyzed to record the Distant metastasis primary disease, tongue defect, tissue flap type, and post- M0 61 93.8 operative complications. Case inclusion criteria were ad- M1 4 6.2 vanced tongue or mouth cancer, complete or near-total Clinical stages tongue defect after tumor resection, and free tissue flap to I 3 4.6 repair tongue defect at the same time. /e total tongue defect II 10 15.4 III 29 44.6 refers to the defect of the tongue and tongue root tissue, and IV (IVaIVbIVc) 23 35.4 the proximal tongue defect includes 2/3 in front of the Pathologic diagnosis tongue or most of the tongue (2/3 or more). Other inclusion Squamous cell carcinoma 56 86.2 criteria were free flap survived completely; age less than 75 Other carcinoma 9 13.8 years; no previous or synchronous malignancies; no cog- nitive impairment; at least 12 months after reconstruction; and patients with recurrence of the disease. saliva, mood, and anxiety), and 3 are global questions. /e remaining patients received a formal letter Each of the 12 questions included has 3–6 choices of explaining the study, an informed consent form, and the response. /e domains are scored on a scale ranging from University of Washington quality of life (UW-QoL)/the 14- 0 (worst) to 100 (best). /e standard UW-QoL is available item Oral Health Impact Profile (OHIP-14). /ose patients in Chinese and has been validated for a Chinese pop- who did not reply within one month received a reminder. ulation [8] according to the methods of our past research Patients who were not able to fill in the questionnaires [9]. themselves, e.g., due to dementia or language were excluded from the study. Patient characteristics are summarized in 3.Results Table 1. 3.1. Patient Characteristics. /e patients’ demographic and TNM/clinical stages are listed in Table 1. Of the 65 patients 2.1. Questionnaires and Data Collection. Although many who completed questionnaires, patients were staged generic QOL instruments have been developed over the according to the 2010 American Joint Committee on Cancer past 30 years, the University of Washington quality of life (AJCC) staging system; their main clinical characteristics are (UW-QoL) [8] and OHIP-14 consists of 14 items divided listed in Table 1. In our research, more than half our patients into 7 domains: functional limitation, physical pain, had had little education, 18 patients could not read or write psychological discomfort, physical disability, psycholog- and needed help to complete the questionnaire, 5 patients ical disability, social disability, and handicap. Each item is were orphans, and 7 patients lived alone. scored as 0 � never; 1 � hardly ever; 2 � sometimes; But even in this, 65 of the 79 questionnaires (82.27%) 3 � fairly often; and 4 � very often. /e domains are scored were completed, SF-36 and OHIP-14, at one or two time on a scale ranging from 0 (best) to 100 (worst). /e higher points during the treatment and follow-up periods. /e time the score, the poorer the patient’s state of health. /e needed for completing both questionnaires is very accept- standard OHIP-14 is available in Chinese and has been able and makes it feasible to use them in clinical studies. validated for a Chinese population [8]. /e UW-QoL scale Data for the SF-36 and OHIP-14 scales at 12 months after is filled in by the patient and provides a broad measure of TFFF are shown in Tables 2 and 3. In TNM stages research QoL for patients with head and neck cancer with good studies, we found that most patients had T3-T4 stage tumors acceptability, practicality, validity, reliability, and re- and only a few T1 and T2 stages. /is may be because sponsiveness. /e questionnaire is composed of 15 do- patients with T1-T2 stage tumors had small tumors that did mains: 12 are disease-specific (pain, appearance, activity, not need AFFF reconstruction. recreation, swallowing, chewing, speech, shoulder, taste, Journal of Oncology 3 Table 2: Means of scores of items and scales of University of vascular pedicle, and contour ability and maintains con- Washington Quality of Life questionnaire. sistent volume and surface area over it. AFFF helped to shift focus away from simple coverage of defects towards mini- Number of cases (n � 65) mizing morbidity at the donor site, refining the flap, Domain Mean Median Percentage with score selecting the most appropriate donor tissue, reducing bulk, (SD) (range) 80+ and reconstructing defects in a functional, three-dimen- Pain 42.7 (4.5) 43 (20–65) 0 sional manner, and it was recognized as the method of Appearance 56.8 (5.4) 58 (40–82) 4 choice for reconstruction of soft tissue defects in the oral Activity 65.3 (10.7) 66 (35–86) 9 cavity and oropharynx, especially in tongue cancer. Recreation 56.1 (6.2) 57 (30–70) 0 For patients with total and near-total glossectomy, oral Swallowing 43.8 (9.3) 44 (15–66) 0 feeding and speech function are largely dependent on flap Chewing 41.2 (13.2) 42 (10–65) 0 Speech 53.2 (6.4) 54 (0–70) 0 reconstruction to restore tongue morphology and dynamic Shoulder 78.6 (11.3) 79 (60–88) 15 function. Kimata et al. [14] divided the shape of the Taste 65.4 (7.5) 66 (10–75) 0 reconstructed tongue into the oral cavity into four types: Saliva 61.2 (8.5) 63 (30–85) 8 bulge type, semi-uplift type, flat type, and concave type. Mood 61.9 (7.9) 62 (40–75) 0 Among them, the bulging type and the semi-uplift type are Anxiety 70.5 (6.7) 71 (45–86) 12 basically in contact with the upper jaw when the mouth is closed, and the gap between the oropharynx is narrow, 3.2. UW-QOL. /e scores for the 12 disease-specific do- which is conducive to the recovery of eating and language function. In order to the reconstructed tongue to reach a mains and the importance of each domain are shown in Table 2. At the top of the list of high-scoring domains were bulge and a semiembossed configuration, the repaired tissue shoulder and anxiety. 15 patients scored 80% or more for is required to have a sufficient and relatively constant vol- anxiety (mean (SD) 70.5 (6.7) points). /e best-scoring ume. /erefore, the key point of functional recovery after domain was shoulder, with a mean (SD) score of 78.6 (11.3) total tongue and near-total tongue reconstruction is the amount of flap tissue. /e free anterolateral thigh flap can points. /e worst score was for chewing, with a mean (SD) score of 41.2 (13.2) points. All patients were dissatisfied with provide a large amount of soft tissue and can carry part of muscle tissue, which is beneficial to recovery of oral function chewing, speech, recreation, and pain. In the selection of the most important of the 3 domains, chewing was considered in postoperative patients. In the assessment of any therapy, particularly for cancer most important, followed by speech and swallowing. /e domains pain, swallowing, and taste were the least important patients, analysis of QOL represents the ultimate step of the evaluation process. QOL has recently become a constant to patients. preoccupation in the assessment of any therapy in oncology. Some authors describe QOL as welfare state along with 3.3. OHIP-14. Distributions of OHIP-14 domain scores at patient’s satisfaction. Other authors relate QOL as the dif- presentation are shown in Table 3. /e best mean (SD) ference between the patient’s expectations and what they can domain scores for the complete group were 30.2 (5.6) for really perceive. Assessment of QOL can now be used in an handicap, 43.8 (8.7) for psychological disability, and 45.2 attempt to improve treatment outcomes, and to measure (11.2) for social disability. /e highest scores were for success or failure in cancer treatment has been survival, psychological disability and physical pain. understood as a period free of disease. Completion of questionnaires can help put into context what other patients report as their outcome after intervention allowing greater 4.Discussion patient-doctor interactions and understanding. It also allows Oral cancer is one of the most common malignant tumors in expressions of concern that the patient is otherwise reluctant the body. /e incidence of tongue cancer in oral cancer is the to mention. Nevertheless, few studies have assessed QOL in highest. Recent studies at home and abroad have shown that our field of interest. In our study, we used the UW-QOL and the incidence of oral cancer is on the rise in the world [10], OHIP-14 questionnaires to assess the postoperative QOL of these patients and the possible relation to surgery. and the age of the disease tends to be younger [11]. Tongue cancer has the characteristics of high malignancy, high local /e UW-QOL measure was chosen as the oral-specific questionnaire that provided a broad measure of QOL for recurrence rate, high cervical lymph node metastasis rate, and often endangers patients’ lives. /erefore, the best patients with tongue cancer with good acceptability, practi- cality, validity, reliability, and responsiveness. Language is choice is surgical radicalization. At present, most of the surgery is based on comprehensive treatment [12]. At simple, but because individual response options are provided present, it is generally acknowledged that free flaps transfer for each question rather than using a standardized scale, the with microvascular anastomosis is the favored method for reading burden is high. Each item is scored from 0 to 100, with reconstruction after major oral cancer surgery [13]. Yang higher scores indicating better QOL, resulting in a summary score of 0–900 for the disease-specific items, and each question et al. first made the radial free forearm flap (RFFF) in 1981, which was a major breakthrough in reconstructive surgery has 3–6 response options. It is brief and appropriate, so it can be used on a regular basis with low cost. It presents an ad- and appreciated in this type of reconstruction. It is a free tissue transfer characterized by thinness, pliability, a long ditional module, which evaluates emotional status and anxiety. 4 Journal of Oncology Table 3: Means of scores of items and scales of Oral Health Impact Profile-14 questionnaire. Number of cases (n � 65) Domain Mean (SD) Median (range) Score 40 or fewer (%) Functional limitation 52.3 (4.5) 53 (20–66) 11 Physical pain 55.3 (5.4) 56 (15–82) 14 Psychological discomfort 51.7 (10.1) 53 (20–73) 18 Physical disability 71.2 (9.2) 72 (30–80) 8 Psychological disability 43.8 (8.7) 44 (15–66) 36 Social disability 45.2 (11.2) 46 (10–60) 22 Handicap 30.2 (5.6) 30 (0–45) 55 In our study, many authors have chosen to use the UW-QOL patients in a more advanced stage. /e cervical dissection questionnaire [8], and the highest score in the UW-QOL along with the scar consequence of the surgical recon- subscales was in the domain shoulder. /e mean (SD) score struction with a myocutaneous pediculed flap is a combi- was 78.6 (11.3), which indicated slight damage in the shoulder nation that in a most important way influences in patient’s complaints on esthetic and pain in the reconstructed lo- domain. As well as shoulder and patients scored high for anxiety (70.5 (6.3)) and taste (65.4 (7.5)), which indicates that cation [18]. Little shoulder dysfunction has been reported with unilateral selective neck dissections (level I–III/IV) as the operation, had little effect on the functions of taste and anxiety. As well as the domain of pain, chewing, and swal- compared with no dissection. During our study, significantly lowing were lower than others because of tongue cancer worse shoulder function was also found if selective neck characteristics, patients reluctant to communicate with other, dissections were bilateral or extended to level V. especially when sharp stimulus contained sharp teeth or /ere were limitations that could influence the result of dentures around primary tumor in our study. our findings. We described oral cancer in the study pop- We used the Chinese version of the OHIP-14, which has ulation at one point in time, and so could not fully assess its been translated and validated for use in Hong Kong and impact on patients’ QOL over the whole postoperative China [15]. /e best mean (SD) domain scores for the period. Under these circumstances, QOL assessment is quite a new area, and the emphasis is placed on clinical practice complete group were 30.2 (5.6) for handicap, 43.8 (8.7) for psychological disability, and 45.2 (11.2) for social disability. and research. Considerable effort should therefore be put into it. QOL should be acknowledged as an important /e highest score was for physical disability (71.2 (9.2)), and no patients scored 40%. For the physical disability questions, outcome, together with traditional biomedical outcomes. we asked “Has your diet been satisfactory because of your teeth, mouth, or dentures?” and “Have you had to interrupt 5.Conclusion meals because of your teeth, mouth, or dentures?” No pa- In total and near-total tongue cancer postoperative free flap tient was satisfied with the degree of physical disability. Loss for reconstruction, QQL assessment is quite a new area, and of teeth greatly weakened the patients’ oral function. the emphasis is placed on clinical practice and research. Total tongue resection and the extent of local lesion /erefore, considerable effort should be paid to this area. resection are large; patients with malignant tumors need to QQL should be acknowledged as an important outcome undergo unilateral or bilateral neck dissection, and free flap parameter, along with the traditional biomedical outcomes. transplantation at the same time has the problems of Clinically, QQL should be used as a part of tongue cancer complicated operation, large trauma, and long duration. In treatment, and this should be considered for surgical addition, such patients usually require tracheotomy, and the planning. ALTFF for reconstruction of defects of tongue possibility of postoperative pulmonary infection is high. At significantly influenced QOL. the same time, due to poor tongue swallowing function, the possibility of aspiration after surgery is also high, resulting in Data Availability inhalation pneumonia, leading to a series of postoperative complications. Moreover, patients with postoperative head /e data used to support the findings of this study are in- brakes need to rest in bed for a long time, which is easy to cluded within the article. cause complications for patients with poor cardiopulmonary function. /erefore, the general anesthesia should be used to Conflicts of Interest evaluate the general condition of the patient before surgery, and the preoperative examination should be improved to /e authors declare that there are no conflicts of interest deal with adverse reactions. regarding the publication of this paper. Because of the rich supply of lymph and blood and tongue cancer more prone to lymph node metastasis and Acknowledgments blood metastasis, cervical dissection must be carried out during operation. 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Published: Oct 10, 2020

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