SENSORY RECOVERY IN NONINNERVATED FLAPS USED FOR ORAL CAVITY AND OROPHARYNGEAL RECONSTRUCTION

Objectives: To assess the clinical recovery of sensation in noninnerva ted flaps used for oral cavity and oropharyngeal reconstruction To cor relate the return of flap sensation to articulation and swallowing. De sign: Prospective nonrandomized study. Six months minimum follow-up. S etting: Tertiary care center. Patients: From April 1, 1991, to May 31, 1993, 12 patients underwent resection of stage III or greater squamou s cell carcinoma of the oral cavity or oropharynx. Ten patients were p reviously untreated; two had failed previous full-course radiation the rapy. Reconstruction was performed with either a pedicled musculocutan eous flap (four patients) or a fasciocutaneous free flap (eight patien ts). Flap sensation to touch, sharp vs dull, two-point discrimination, and warm vs cold was evaluated in each of these patients at monthly i ntervals by two independent observers. In addition, an extensive evalu ation of articulation and swallowing was performed on all 12 patients a minimum of 6 months after surgery. Results: Recovery of flap sensati on was documented in 10 patients (83%) (eight of eight with fasciocuta neous free flaps and two of four with musculocutaneous flaps), with a strong trend for sensory recovery with the fasciocutaneous free flaps over the musculocutaneous flaps (P = .09). Sensory recovery correlated statistically with articulation (P = .045) and oral intake (P = .045) . Patients who underwent reconstruction of base of tongue defects had significantly worse articulation and swallowing than those who underwe nt reconstruction of other sites (P = .04). No statistically significa nt correlation was found between patient age, flap size, history of ir radiation, or length of follow-up (> 6 months) and flap sensation, art iculation, or swallowing. Conclusions: Spontaneous return of flap sens ation was documented by clinical testing in the majority (83%) of pati ents who underwent reconstruction of oral cavity or oropharyngeal defe cts with noninnervated flaps. Sensory recovery occurred more often in patients with fasciocutaneous free flaps (100%) than in those with mus culocutaneous flaps (50%). Articulation and swallowing correlated stat istically with the return of flap sensation.