Reconstruction of the anterior floor of the mouth with free flaps: oncological and functional results

Introduction: The purpose of this retrospective study was to evaluate oncol ogical and functional results after reconstruction of the anterior floor of the mouth using free flaps. Methods: From 1992 to 1998, 30 patients with squamous cell carcinoma of the anterior floor of the mouth underwent surgical excision and primary recons truction with either free forearm- or bone-composed flaps. Functional asses sment included evaluation by the Karnofsky scale, Performance Status Scale for Head and Neck Cancer (PSS-HNC), articulation rest and videofluoroscopic examination. Results: 16 patients underwent reconstruction with a free forearm flap, 13 with an iliac crest flap and 1 with a fibula flap. The most serious local c omplication was partial flap necrosis in two cases. Local control was 90% a t 24 months and the specific survival rate was 92% at five years. Functiona l evaluation was performed on 19 patients: PSS-HNC median score for diet wa s 70 (range 50-100), the score for speech was 70 (range 50-100) and the sco re for "eating in public" was 65 (range 25-100). Patients with a major mobi le tongue resection had a lower score compared to patients with minor or no mobile tongue resection. Videofluoros-copy showed swallowing alterations f ollowing large of soft tissues. Discussion: Our study confirms that wide resection of mobile tongue is asso ciated decreased rehabilitation quality. Mandibulectomy does not influence rehabilitation.