REESTABLISHMENT OF SPEECH AND SWALLOWING FUNCTION FOLLOWING EXTENSIVETUMOR RESECTIONS IN THE HEAD AND NECK

Background: Following extensive resections of head and neck tumours, r e-establishing speech and masticatory function are of crucial importan ce for the patient. Methods: In 23 patients with vascularised jejunal grafts for reconstruction of the intraoral mucosa, tongue and floor of mouth, a speech intelligibility test was performed, tongue and floor of mouth mobility was investigated using a 3.5 MHz ultrasound scanner. In another 18 patients with vascularised bone grafts for reconstructi on of the mandible, masticatory function was analysed using a T-scan s ystem and a miniature pressure transducer. Results: Speech results wit h jejunal grafts in the lateral floor of mouth/tongue region may attai n 91.4%, in anterior floor of mouth reconstructions 63.4%. Patients wi th implant-borne dentures and vascularised bone grafts prefer the non- reconstructed side for chewing. Masticatory force is significantly dim inished compared to a control group. Discussion: Lack of neurosensitiv e feedback mechanisms may be responsible for diminished chewing pressu re and also for inferior speech results despite good floor-of-mouth/to ngue mobility. Conclusions: Despite complex microvascular tissue recon structions, severe functional impairments remain and necessitate furth er investigations on improvement of postoperative speech, swallowing a nd chewing function.