Cine-MRI swallowing evaluation after tongue reconstruction.

OBJECTIVE To determine the feasibility of cine-MRI for non-invasive swallowing evaluation after surgery for lingual carcinoma with reconstruction using microvascular free flaps. METHODS Ten patients with stage IV carcinoma of the mobile tongue and/or tongue base treated by surgical resection and reconstruction with a free flap were evaluated after an average of 4.3 years (range: 1.5-11 years), using cine-MRI in "single-shot fast spin echo" (SSFSE) mode. Fiberoptic laryngoscopy of swallowing was performed before MRI to detect aspiration. The tolerance and ability to complete the exam were noted. The mobilities of the oral and pharyngeal structures visualized were evaluated as normal, reduced or increased. RESULTS Cine-MRI was well tolerated in all cases; "dry" swallow was performed for the 2 patients with clinical aspiration. Tongue base-pharyngeal wall contact was observed in 5 cases. An increased anterior tongue recoil, increased mandibular recoil, increased posterior oropharyngeal wall advancement and an increased laryngeal elevation were observed in 4 cases. One case of a passive "slide" mechanism was observed. CONCLUSIONS Cine-MRI is a safe, non-invasive technique for the evaluation of the mobility of oral and oropharyngeal structures after free-flap reconstruction of the tongue. For selected cases, it may be complementary to clinical examination for evaluation of dysphagia after surgery and free-flap reconstruction. Further technical advances will be necessary before cine-MRI can replace videofluoroscopy, however.

[1]  O M Weber,et al.  Evaluation of the anatomical and functional properties of deglutition with various kinetic high‐speed MRI sequences , 2001, Journal of magnetic resonance imaging : JMRI.

[2]  Jörg F. Debatin,et al.  Visualization of swallowing using real-time TrueFISP MR fluoroscopy , 2001, European Radiology.

[3]  B. J. Bailey,et al.  Head and Neck Surgery--Otolaryngology , 1999 .

[4]  L. Donnelly,et al.  Cine Magnetic Resonance Imaging: Evaluation of Persistent Airway Obstruction after Tonsil and Adenoidectomy in Children with Down Syndrome , 2004, The Laryngoscope.

[5]  D. Carter.  TNM Classification of Malignant Tumors , 1998 .

[6]  W. Armstrong,et al.  Functional hemitongue reconstruction with the microvascular ulnar forearm flap. , 1999, Plastic and Reconstructive Surgery.

[7]  V. Strelzow,et al.  Secondary microvascular tongue reconstruction: Functional results , 1993, Head & neck.

[8]  M. Urken,et al.  A systematic approach to functional reconstruction of the oral cavity following partial and total glossectomy. , 1994, Archives of otolaryngology--head & neck surgery.

[9]  Y. Suto,et al.  Technical note: dynamic analysis of the pharynx during swallowing using Turbo-FLASH magnetic resonance imaging combined with an oral positive contrast agent--a preliminary study. , 1995, The British journal of radiology.

[10]  D. Hartl,et al.  Morphologic Parameters of Normal Swallowing Events Using Single-Shot Fast Spin Echo Dynamic MRI , 2003, Dysphagia.

[11]  U Klose,et al.  Stroboscopic articulography using fast magnetic resonance imaging. , 2000, International journal of language & communication disorders.

[12]  S. Shapshay,et al.  Echo‐Planar Magnetic Resonance Imaging of Deglutitive Vocal Fold Closure: Normal and Pathologic Patterns of Displacement , 1996, The Laryngoscope.

[13]  Wataru Hida,et al.  Quantitative Assessment of the Pharyngeal Airway by Dynamic Magnetic Resonance Imaging in Obstructive Sleep Apnea Syndrome , 2001, The Annals of otology, rhinology, and laryngology.

[14]  R A Faust,et al.  Real‐Time, Cine Magnetic Resonance Imaging for Evaluation of the Pediatric Airway , 2001, The Laryngoscope.

[15]  R. Gilbert,et al.  Patterns of lingual tissue deformation associated with bolus containment and propulsion during deglutition as determined by echo‐planar MRI , 1998, Journal of magnetic resonance imaging : JMRI.

[16]  D. Hartl,et al.  Cine Magnetic Resonance Imaging with Single-Shot Fast Spin Echo for Evaluation of Dysphagia and Aspiration , 2006, Dysphagia.

[17]  R. Bastian,et al.  Videoendoscopic Evaluation of Patients with Dysphagia: An Adjunct to the Modified Barium Swallow , 1991, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.