Sensation recovery on innervated radial forearm flap for hemiglossectomy reconstruction by using different recipient nerves

The objectives of this study were (1) to determine the extent of sensory re covery on hemitongues reconstructed with innervated radial forearm flaps an d (2) to assess the influence of various clinical and surgical factors ol e r the return of sensation, including the use of different recipient nerves for neurorrhaphy. Twenty-eight patients with tongue cancer who underwent he miglossectomy and primary reconstruction with innervated radial forearm fla ps over a 3-year period were studied. Mean postoperative follow-up was 18.2 months (range 6 to 32 months). Sensory recovery was assessed in a blind ma nner by two examiners that used (1) static two-point discrimination, (2) li ght touch sensation, (3) pain perception, and (4) hot and cold temperature perception. Different surfaces were assessed with each method on the recons tructed hemi-tongue and on the intact contralateral hemitongue (used as con trol). The following factors and their relationship with flap sensory recov ery were analyzed: age, smoking history, size of the reconstructed defect, administration of postoperative radiation therapy, recipient nerve, and neu rorrhaphy technique. Comparative statistical analysis (p < 0.05) between bo th hemitongues was performed using paired t test followed by Bonferroni cor rection for static two-point discrimination and light touch sensation. Fish er exact test analysis was used for pinprick and hot and cold temperature p erception. The control side was ignored in analyzing the effects of the ris k factors. The tip, dol-sal aspect, ventral surface, and floor of mouth on the reconstructed hemitongue had comparable static two-point discrimination when compared with the intact hemitongue. Light touch sensation was also s imilar in the tip and dot sal aspect of both hemitongues; however, a statis tically sig nificant difference (p < 0.05) was observed on the ventral surf ace and floor of mouth of the reconstructed hemitongues. Likewise, pain per ception was significantly decreased in the floor of the mouth, compared wit h other surfaces. No clearly dependent association was established between return of flap sensation and age, tobacco use, and size of the reconstructe d defect. Light touch sensation, pain, and temperature perception were sign ificantly decreased when the patients had received postoperative radiation therapy. In addition, all four sensory tests were significantly diminished (p < 0.05) when the recipient nerve used for neurorrhaphy was a nerve other than the lingual or the inferior alveolar nerve, and also when an end-to-s ide nerve repair was used. Sensation recovery of the innervated radial fore arm flap after hemitongue reconstruction approaches normal compared with th e contralateral intact hemitongue. Lower return of sensation may be anticip ated in patients Mho receive postoperative radiotherapy. Good. recovery of sensation is predictable when either the lingual or inferior alveolar nerve is used for neurorrhaphy in contrast to using other recipient nerves.