구인두암종 환자의 조음 및 연구개기능의 술후 평가

Abstract

Background and Objectives : Velopharyngeal insufficiency from wide resection of soft palate and pharyngeal wall cause swallowing and articulation difficulty. Recently, reconstruction options have been significantly expanded and revitalized by the advent of free tissue transfer. The purpose of the present study was to report retrospectively collective articulation function scores and velopharyngeal function in patients who had reconstruction of radial forearm free flaps after primary resection for oropharyngeal cancer. Subjects and Method : Ten patients treated for oropharyngeal cancer by wide excision of primary lesion and reconstruction with radial forearm free flap were included. Assessment of speech intelligibility, diadochokinetic test, articulation discrimination test, nasometer, and velopharyngeal orifice examination with fiberoptic nasopharyngoscope was accomplished. Ten patients were classified into 4 groups according to the extent of surgical defect and portion of resection as follows. Group I : only one side of the lateral pharyngeal wall and palatine tonsil area (n=2), Group II : One side of palatine tonsil and soft palate (n=3), Group III : One side of palatine tonsil, soft palate, and part of the posterior pharyngeal wall (n=2), Group IV : One side of palatine tonsil, soft palate which reached beyond the uvula to opposite side, and part of the posterior pharyngeal wall (n=3). Results : In the speech intelligibility and articulation discrimination test, five cases which belonged to the group I and II were evaluated to show excellent state. Five cases which belonged to group III and IV were judged to show moderate state. These results resulted from hypernasality of patients in group III and IV. In the articulation discrimination test, the results was increasingly affected with hypernasality from group I to group IV. In the nasometer test, patients of group III and IV were judged to show higher nasalance scoress (nasality) than those of group I and II. In the velopharyngeal orifice examination with fiberoptic nasopharyngoscope, near perfect closure or complete closure was achieved in an effort to bring about velopharyngeal closure in group I and II. But a small space was evident in the side reconstructed with a free flap in group III. In group IV, velopharyngeal space was not closed. Conclusion : We believe that this study aids in counseling patients and predicting their postoperative status of speech and velopharyngeal function according to the size of primary defect and the design of reconstruction. But, a prospective, randomized study will be needed for better evaluation.