Wiederherstellung der sprech- und kaufunktion nach ausgedehnten tumorresektionen im kiefer-gesichtsbereich

Background: Following extensive resections of head and neck tumours, re-establishing speech and masticatory function are of crucial importance for the patient. Methods: In 23 patients with vascularised jejunal grafts for reconstruction of the intraoral mucosa, tongue and floor of mouth, a speech intelligibility test was performed, tongue and floor of mouth mobility was investigated using a 3.5 MHz ultrasound scanner. In another 18 patients with vascularised bone grafts for reconstruction of the mandible, masticatory function was analysed using a T-scan system and a miniature pressure transducer. Results: Speech results with jejunal grafts in the lateral floor of mouth/ tongue region may attain 91.4%, in anterior floor of mouth reconstructions 63.4%. Patients with implant-borne dentures and vascularised bone grafts prefer the non-reconstructed side for chewing. Masticatory force is significantly diminished compared to a control group. Discussion: Lack of neurosensitive feedback mechanisms may be responsible for diminished chewing pressure and also for inferior speech results despite good floor-of-mouth/tongue mobility. Conclusions: Despite complex microvascular tissue reconstructions, severe functional impairments remain and necessitate further investigations on improvement of postoperative speech, swallowing and chewing function.