Articulation skills and speech intelligibility in patients with orofacial cancer: A comparison between pre- and postoperative results using three different reconstructive techniques

Radical orofacial tumor resections often result in speech and swallowing dysfunctions. Thus, both communication ability and life quality can be markedly impaired in patients. Dysfunction is mostly related to the amount of tissue removed and the reconstruction technique used. In this prospective study, pre- and postoperative speech intelligibility following reconstruction with either local grafts, free jejunal flaps or myocutaneous/fasciocutaneous flaps was examined by subjective assessment of monosyllables chosen from the Freiburg audiometry test (''reverse speech intelligibility test''). It was shown that linguodental affricates and dorsofaucal plosives were especially affected, even pre operatively, in patients with T3 and T4 tumors, while additional deterioration of speech function occurred postoperatively. When comparing reconstruction techniques, use of local grafts showed less postoperative deterioration in the patients with T3 and T4 tumors (expert rating/student rating -5.0%+/--3.8%), whereas impairment was much more evident when jejunal flaps (expert rating/student rating -27.9%+/--35.1%) and myocutaneous and fasciocutaneous flaps (expert rating/ student rating -34.2%+/--48.1%) were used. Results demonstrated that patients should be informed about negative side effects following radical tumor resections and reconstructions of large tissue defects. Surgery should avoid marked motor and sensory nerve lesions whenever possible. Before speech therapy is begun, speech function should be examined carefully Speech intelligibility should also be documented, e.g. with audio tapes, for quality assessment.