Oral Cavity Obliteration is a Novel Predictor of Functional Outcomes after Glossectomy Reconstruction.

The primary goal for reconstruction of oral tongue defects is to improve speech and swallowing. We hypothesize that degree of oral cavity obliteration will correlate to a specific functional outcome. The purpose of this study is to present a new reconstructive metric that uses volume displacement to measure oral cavity obliteration and correlate this metric to outcomes of speech and swallowing. 33 patients (23m:10f, 51.mean age) underwent resection and template based free-tissue reconstruction of oral tongue defects based on the principle of maintaining oral cavity obliteration. All patients were followed for greater than 12 months postoperatively. Oral cavity obliteration was measured by using a novel oral volume assessment test (OVAT). Briefly, by placing a latex balloon filled with dyed pudding on the patient's tongue and then patients performed mouth closure to expel the pudding. The residual volume represented dead space in the oral cavity and was measured by water displacement. These results were correlated with the Speech and Swallowing Assessment and Assessment of Intelligibility of Dysarthric Speech (A.I.D.S.) instruments. The mean residual volume on OVAT was 7.4 cc (range 3 – 20cc; sd 4.5cc). The mean AIDS efficiency ratio was 0.6055 (range 0.31 - 0.92; sd 0.16) and mean AIDS % sentence intelligibility was 96% (range 64.1 – 100; sd 8.0). There was a correlation with lower residual volumes (better obliteration) with increasing AIDS efficiency ratio (R = 0.72, p < 0.001). A receiver operator curve was used to identify 10 cc of residual volume as the curve where the inflection defines better versus worse outcomes. Using this cut point, binary logistic regression showed that residual volume significantly predicts normal nutritional mode (p<0.001), ability to tolerate all liquids (=0.007), range of solids (p=0.004), eating in public (p=0.007), understandability (p<0.001), and speaking in public (p=0.01). Oral volume assessment test (OVAT) is a novel measure of residual volume (obliteration) that correlates with improved speech efficiency, intelligibility, speaking in public and swallowing outcomes. [ABSTRACT FROM AUTHOR]