Aspiration Patterns Observed in Patients With Free Flap Reconstruction Following T3 and T4 Tongue and Oropharyngeal Cancer Surgery: A Fiberoptic Endoscopic Evaluation of Swallowing

Background and Objectives The objectives of this study were to investigate the aspiration patterns in patients with T3 and T4 oral and oropharyngeal cancers after free flap reconstruction following primary tumor resection and determine the effect of tongue base resection on aspiration patterns in these patients. Subjects and Method The aspiration pattern was evaluated via fiberoptic endoscopic evaluation of swallowing and classified into three groups based on the timing of aspiration in relation to the swallowing process. More than two types of aspiration patterns observed simultaneously in a patient suggested combined aspiration pattern. Results The major pattern of aspiration in 31 patients with oral cavity cancer was aspiration after swallowing in the group with base of tongue (BOT) preserved (83.3%, 10/12) and combined aspiration in the group with BOT resection (63.2%, 12/19), showing a significant difference in aspiration pattern between the two groups (p<0.001). In oropharyngeal malignancies, the major pattern of aspiration was aspiration after swallowing in both BOT-preserving (87.5%, 21/24) and BOT-resecting groups (75.0%, 9/12), showing a significant difference in aspiration pattern between the two groups (p=0.031). Conclusion The most common pattern observed in the advanced T stage tongue cancer patients after glossectomy was aspiration after swallowing. Resection of BOT greater than 25% in the tongue and oropharyngeal cancer was a significant factor causing the combined type of aspiration.