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[Reconstruction of the anterior mouth floor by surgical flap microanastomosis: oncologic and functional results].

INTRODUCTION
The purpose of this retrospective study was to evaluate oncological 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 reconstruction with either free forearm- or bone-composed flaps. Functional assessment included evaluation by the Karnofsky scale, Performance Status Scale for Head and Neck Cancer (PSS-HNC), articulation test 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 complication was partial flap necrosis in two cases. Local control was 90% at 24 months and the specific survival rate was 92% at five years. Functional evaluation was performed on 19 patients: PSS-HNC median score for diet was 70 (range 50-100), the score for speech was 70 (range 50-100) and the score for "eating in public" was 65 (range 25-100). Patients with a major mobile tongue resection had a lower score compared to patients with minor or no mobile tongue resection. Videofluoroscopy showed swallowing alterations following large resections of soft tissues.


DISCUSSION
Our study confirms that wide resection of mobile tongue is associated decreased rehabilitation quality. Mandibulectomy does not influence rehabilitation.