ARTICULATION SKILLS AND SPEECH-INTELLIGIB ILITY IN PATIENTS WITH OROFACIAL CANCER - A COMPARISON BETWEEN PREOPERATIVE AND POSTOPERATIVE RESULTS USING 3 DIFFERENT RECONSTRUCTIVE TECHNIQUES

Radical orofacial tumor resections often result in speech and swallowi ng dysfunctions. Thus, both communication ability and life quality can be markedly impaired in patients. Dysfunction is mostly related to th e amount of tissue removed and the reconstruction technique used. In t his prospective study, pre- and postoperative speech intelligibility f ollowing reconstruction with either local grafts, free jejunal flaps o r myocutaneous/fasciocutaneous flaps was examined by subjective assess ment of monosyllables chosen from the Freiburg audiometry test (''reve rse speech intelligibility test''). It was shown that linguodental aff ricates and dorsofaucal plosives were especially affected, even pre op eratively, in patients with T3 and T4 tumors, while additional deterio ration of speech function occurred postoperatively. When comparing rec onstruction techniques, use of local grafts showed less postoperative deterioration in the patients with T3 and T4 tumors (expert rating/stu dent rating -5.0%+/--3.8%), whereas impairment was much more evident w hen jejunal flaps (expert rating/student rating -27.9%+/--35.1%) and m yocutaneous and fasciocutaneous flaps (expert rating/ student rating - 34.2%+/--48.1%) were used. Results demonstrated that patients should b e informed about negative side effects following radical tumor resecti ons and reconstructions of large tissue defects. Surgery should avoid marked motor and sensory nerve lesions whenever possible. Before speec h therapy is begun, speech function should be examined carefully Speec h intelligibility should also be documented, e.g. with audio tapes, fo r quality assessment.