当院の舌癌再建患者における切除範囲と構音機能の評価

Evaluation of Speech Intelligibility and Resection Area in Patients Who Underwent Tongue Reconstruction after a Glossectomy

はじめに

　舌癌切除後再建の主な目的は，良好な嚥下機能と構音機能の獲得であり，いずれも術後の患者QOLに大きく影響を与える。今回，当院の舌癌再建患者の術後構音機能を評価し，切除部位と範囲および再建舌形状，術後放射線治療の影響などを比較検討したため報告する。

　Reconstruction is often done after the resection of tongue cancer in an effort to provide the patient with good swallowing and speech function. We used the TKR speech test to evaluate the postoperative speech intelligibility of Japanese patients following tongue reconstruction after their glossectomies for oral cancer. The average age of the 56 participants（35 men, 21 women）was 58.9 years. Five TKR items were examined and compared: the amount of the oral tongue that was excised, the amount of the base of the tongue excision, the use or non-use of postoperative radiation therapy, the type of flap used, and the shape of the reconstructed tongue. The results of our analyses demonstrated that the amount of excised oral tongue, the use of radiation therapy, and the shape of the reconstructed tongue greatly influenced the patientsʼ speech intelligibility. The amount of tongue base excision also tended to affect the articulation of the letter “K”, which is related to the articulation position. The comparison of flaps used revealed that the speech intelligibility of the forearm flap was good; however, this may be due to the bias of using forearm flaps for half-tongue resection and other flaps for subtotal resection.