Functional outcome after transmandibular resection and primary chemoradiation in advanced oropharyngeal squamous cell carcinoma

Objective The aim of this study was to assess the functional outcome after transmandibular resection and reconstruction via a radial forearm flap (TMR+RFF) compared to primary chemoradiotherapy (pCRT) in advanced oropharyngeal squamous cell carcinoma (OPSCC). Methods The study compared 50 OPSCC patients treated with TMR+RFF to 50 OPSCC patients receiving pCRT. The time taken to swallow water served as the primary endpoint. The Saxon test, maxillomandibular distance, Mallampati score, ratio of height to weight, nasal penetration, tracheostomy/gastral tube requirement, and four validated questionnaires (visual analog scale for xerostomia, Sicca VAS; MD Anderson Dysphagia Inventory, MDADI; Voice Handicap Index, VHI; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Head and Neck Cancer, 35 items, QLQ-H&N35) were applied to access functionality and quality of life. Results Patients after TMR+RFF showed an increased rate of nasal penetration (p< 0.0001), which was associated with a longer water swallowing time (p< 0.05). A modified reconstruction of the soft palate significantly decreased the rate of nasal penetration in comparison to classical reconstruction (p= 0.0001). Patients with pCRT suffered significantly more xerostomia (Saxon test) than patients with TMR+RFF and adjuvant therapy. None of the subjective questionnaires revealed significant differences between the groups. Conclusion TMR+RFF with modified reconstruction and adjuvant treatment and pCRT showed comparable functional outcomes.