Swallowing Outcomes in Mandibular Osteoradionecrosis Treated with Free Tissue Transfer

Abstract

Objectives:

Evaluate swallowing outcomes after free tissue transfer (FTT) reconstruction for mandibular osteoradionecrosis (ORN), using aspiration and postoperative tube feed (TF) dependence as surrogates for swallowing ability.

Methods:

Study Design: Case series with chart review. All patients undergoing osteocutaneous FTT reconstruction in an academic tertiary-care hospital for mandibular ORN from 2004-2012 were reviewed. Preoperative patient characteristics, postoperative aspiration, and postoperative TF dependence were noted for each patient. Analysis of patient factors associated with aspiration or TF dependence was performed using Pearson correlation and Fisher’s exact test (when appropriate).

Results:

Sixteen patients met inclusion criteria with an average age of 63.4 years (range 36-81 years) and median follow up of 20 months (range 3-72 months). TF dependence pre- and post-operatively was total dependence in 25% vs. 31%, partial in 25% vs. 31%, and none in 50% vs. 38%, with strong correlation between pre and post-operative TF dependence (r = 0.524, P = 0.04). Aspiration at postoperative follow-up correlated with long-term TF dependence (r=0.701, P < 0.01). Less aspiration was seen after scapular FTT compared to fibular, but this did not reach statistical significance (22% vs. 57% respectively, P = 0.62). Females had lower aspiration rates than males (r = 0.595, P = 0.02), and all females in this study were treated with scapular FTT. Tracheostomy decannulation was achieved in 94% (15/16) of patients.

Conclusions:

TF dependence following osteocutaneous FTT for ORN correlates with pre-operative TF dependence and post-operative aspiration. Aspiration is less likely in females and patients receiving scapular FTT.