Sensory Recovery in Noninnervated Flaps Used for Oral Cavity and Oropharyngeal Reconstruction

Objectives: To assess the clinical recovery of sensation in noninnervated flaps used for oral cavity and oropharyngeal reconstruction. To correlate the return of flap sensation to articulation and swallowing. Design: Prospective nonrandomized study. Six months minimum follow-up. Setting: Tertiary care center. Patients: From April 1, 1991, to May 31, 1993, 12 patients underwent resection of stage III or greater squamous cell carcinoma of the oral cavity or oropharynx. Ten patients were previously untreated; two had failed previous full-course radiation therapy. Reconstruction was performed with either a pedicled musculocutaneous flap (four patients) or a fasciocutaneous free flap (eight patients). Flap sensation to touch, sharp vs dull, two-point discrimination, and warm vs cold was evaluated in each of these patients at monthly intervals by two independent observers. In addition, an extensive evaluation of articulation and swallowing was performed on all 12 patients a minimum of 6 months after surgery. Results: Recovery of flap sensation was documented in 10 patients (83%) (eight of eight with fasciocutaneous free flaps and two of four with musculocutaneous flaps), with a strong trend for sensory recovery with the fasciocutaneous free flaps over the musculocutaneous flaps (P=.09). Sensory recovery correlated statistically with articulation (P=.045) and oral intake (P=.045). Patients who underwent reconstruction of base of tongue defects had significantly worse articulation and swallowing than those who underwent reconstruction of other sites (P=.04). No statistically significant correlation was found between patient age, flap size, history of irradiation, or length of follow-up (>6 months) and flap sensation, articulation, or swallowing. Conclusions: Spontaneous return of flap sensation was documented by clinical testing in the majority (83%) of patients who underwent reconstruction of oral cavity or oropharyngeal defects with noninnervated flaps. Sensory recovery occurred more often in patients with fasciocutaneous free flaps (100%) than in those with musculocutaneous flaps (50%). Articulation and swallowing correlated statistically with the return of flap sensation.