solving aspects, albeit it in a warm and informa tive climate. Possibly as a result, patients generally follow their doctors in the decision making process.

Initiativ es to explain the importance of ‘patient involveme nt’seem to be lackin g.

Conclusi ons: If Problem Solving aspects are confounded with Deci- sion Making ones, the idea that patients prefer deferring to their physician in difficult treatment decisions, might be incorrect.

A true valuation of these findings will emerg e when treatment results have become evident and patients have been able to reflecton their decision making process.

doi:10.1016/j.oraloncolo gy.2013.03.079

OP072

Analysis of swallowi ng pattern via modified barium swallow (MBS) test following treatmen t of head and neck cacner So-yoon Lee a, Hyang ae Shin b, Yoon woo Koh c, Eun chang Choi c,Young hak Park a

a Department of Otorhino laryngology Head Neck Surgery, The Catholic University of Korea, College of Medicine, Republic of Korea b Nationa l Health Insurance Corporation s, Ilsan Hospital, Republi c ofKorea c Departme nt of Otorhino laryngology Head Neck Surgery, Yonsei Uni- versity College of Medicin e, Seoul, Republic of Korea

Purpose : A wider range of treatment options for head and neck can- cer (HNC) have increased adverse effects such as dysphagi a. Long- term use of PEG for nutrition is reported as many as 30% of HNC patients. The purposes of our study were to evaluate patterns of dys- phagia and to identify the factors affecting dysphagia in HNC patien ts.

Materia l and methods: A retrospective analysis was performed of57 patients with various HNCs who underwent treatment since 2008. Patients who complained any dysphagi a sympt oms were eval- uated via MBS test.

36 patients had DARS (dysphagia-aspiration related structure s)primaries. About 70% of the patients had higher clinical stage dis- eases. Various treatmen t modalities were used and radiotherap ywas performed in 71.9% of the patients.

Results : 20 patients were dependant on tube feeding at the initial visit. The characteristic s of tube feeders were older age, DARS prima- ries, higher stage disease and underwent radiotherap y more fre- quently than the normal diet group. MBS findings of tube feeders were reduced BOT retractio n, delayed laryngeal elevation, abnormal CP opening, aspiration and residue. However, only in 13 patients were at grade 7 swallow ing performance scale (SPS) and needed tube feeding. The seven patients who did not know that they could eat by orally before having the test were able to eat orally with the help of diet modification and managemen t.

Higher aspiration rate and higher SPS were found in old age group significantly even with the same disease or treatment than younger age group.

Reduced BOT retractio n was relativel y higher than other dyspha- gia findings and BOT retractio n was affected by clinical stage and treatment including radiotherap y significantly.

Conclusi ons: Swallowi ng tests such as the MBS test is recommend edin especial ly old HNC patien ts with an higher stage disease who has undergone radiotherap y to evaluate exact dysphagi a patterns for proper rehabilitat ion, and to avoid unnecessary tube feeding.

doi:10.1016/j.oraloncolo gy.2013.03.080

OP073

Correlati on of differences in elevation and protrusion to speech and swallowing functio n in hemiglossect omy defects recon- structed with a rectangle tongue template Douglas B. Chepeha a, Matthew E. Spector a, Steven B. Chinn a, Keith A. Casper b, Eric J.P. Chanow ski b, Jeffrey S. Moyer a, Robert Morrison a,Emily Carvill c, Teresa H. Lyden c

a Departme nt of Otolaryngo logy–Head and Neck Surgery , University ofMichiga n, Ann Arbor, MI, USA b Departme nt of Otolaryngo logy–Head and Neck Surgery , University ofCincinnati , Cincinnati, OH, USA c Departme nt of Speech–Language Pathology, Univers ity of Michigan,Ann Arbor, MI, USA

Purpose: There are few studies that have measure d reconstructi vemetrics after tongue reconstructi on and examine d their relationship to speaking and swallowing. The purpos e of this study is to correlate the reconstructi ve metrics of tongue elevation and protrusion with speech and swallowing function in patients with hemiglossec tomy defects reconstruct ed with a rectangl e tongue templat e.

Material and methods: 32 patients (m:f; 18:13 mean age) under- went resection and free-tissue reconstru ction of hemiglossec tomy defects using a rectangle tongue template between 2000 and 2009.The Head and Neck Speech and Swallowi ng Assessment (adminis-tered functional outcomes instrument ) and measure ments of eleva- tion and protrusion were recorded greater than 12 month spostope ratively.

Results: The mean tongue tip elevat ion was 2.4 cm (range 0.5–5.0 cm) and the mean protrusion was 1.4 cm (0–3.6 cm). Elevation of the tongue >1.5 cm correlated with improved scores in nutritional mode (5.8 vs 4.8; p = 0.011), range of liquids (5.9 vs 5.0; p = 0.009),range of solids (5.2 vs 3.6; p = 0.01), eating in public (4.5 vs 3.6;p = 0.039), and understand ability (4.6 vs 3.8; p = 0.012). Protrusion of the tongue greater P0.8 cm correlated with improved scores innutrition al mode (5.8 vs 5.0; p = 0.01), range of solids (5.4 vs 3.6;p = 0.0001), eating in public (4.7 vs 3.4; p = 0.0001), understan dabil- ity (4.6 vs 4.0; p = 0.02) and speaking in public (5.0 vs 4.4; p = 0.004).

Conclusions: The rectangle tongue template for hemiglossec tomy reconstru ction provides effective restoration of speech and swallow- ing function. Tongue elevation and protrusion scores greater than 1.5 and 0.8 cm, respectivel y, are ideal surgical goals for functional speech and swallowing results.

doi:10.1016/j.oraloncology.20 13.03.081

OP074

Swallow ing outcomes in lip and oral cavity cancers : The dys- phagia outcome and severity scale Jan L. Kasperba uer a, Darlene Graner b, Daniel L. Price a, Eric J. Moore a,Kerry D. Olsen a

a Departme nt of Otolaryngolo gy–Head and Neck Surgery , Mayo Clinic,Rochest er, MN, USA b Departme nt of Neurology, Mayo Clinic, Rochest er, MN, USA

Functio nal outcomes following the treatmen t of lip and oral cavity cancers are important determ inants of quality of life. The Dysphagia Outcome and Severity Scale (DOSS) is a validated seven point scale which systematical ly rates the severity of dysphagi a.The scale uses objective findings to develop recommen dations regarding the safety of oral intake, dietary restrictio ns, and the need for cueing of compensat ory strateg ies with swallow ing.

Abstracts / Oral Oncology 49 (2013) S4–S79 S33

The scale is based on three primary functions: oral stage bolus transfer, pharyngeal stage transfe r, and airway protection . This study reports the results of the DOSS obtained in patien ts treated for lip and oral cavity cancer.

Methods: From 2004 to 2010, 504 lip and oral cavity cancers were treated in the Departm ent of otolaryngo logy. 130 patients with pre- viously untreated cancers and 62 patients with recurre nt cancers were evaluate d with a video swallow with speech patholog ist partic- ipation and a DOSS assigned.

Results: Increasing Tstage was associated with increasing dysfunc -tion document ed by the DOSS for previously untreate d lip and oral cavity cancers. 51% of previously untreated patients with T1 and T2 lesions were able to meet all nutrition and hydration needs orally.49% require d at least some alterati on of the diet. Only a single patient treated for recurrent lip and oral cavity cancer demonstrate dsafe and efficient swallowing for all consistenc ies, the ability to eat independ ently unlimited by swallow function, and effective ly use compensat ory strategies when needed. The majority of recurren tcancers, 68%, required alternate methods of feeding or supplemen ts.This level of dysfunction was consistent for recurren t T1, T2, T3, and T4 tumors.

Conclusions: Patients treated for recurrent lip and oral cavity can- cer are significantly limited in the ability to maintain oral intake.Among patients with previous ly untreate d lip and oral cancers who underwent a videoswal low with a speech patholog ist, a variable outcome is docum ented with the majority maintaining all nutrition and hydration orally.

doi:10.1016/j.oraloncolo gy.2013.03.082

OP075

Our experience in surgical treatmen t of oral cavity cancer:Oncologic al and functional results Giovanni Almadori a, Marzia Salgarel lo b, Mario Rigante a, Francesco Bussu a, Liliana Barone Adesi b, Roberto Gallus a, Gaetano Paludet ti a

a Institute of Otorhino laryngology, Catholic University of Sacred Heart,Rome, Italy b Departme nt of Plastic Surgery, Catholic University of Sacred Heart,Rome, Italy

Purpose: The last decade has seen the develop ment of compart- mental surgery (CTS) as a whole new approach to the treatment ofadvanced head and neck cancer. CTS is based on a new concept and a new approach to demoli tion and reconstructi on that focus on: the removal of the whole anatomo-fun ctional units containin gthe tumor, including all the potent ial pathway s of progression such as muscul ar, lymphatic and vascular; identification of territories athigh risk of recurrence of disease such as muscul ar, neuro-vasc ular and glandular tissues; accurate considerati on of the defect resulted from the anatomical demolitio n and the subseq uent rational recon- struction. The aim of this paper is to retrospectivel y evaluate our ser- ies, to describe our experience with CTS and the oncological and functional results in patients with squamocell ular oral cavity cancers of the tongue and the floor of mouth.

Material and methods: In this study we evaluated oncological and functional follow ups of patients treated from 2007 to 2012, by a ret- rospective analysis of the data stored in our oncological digital data- base (Spider’s net). We evaluate d 114 patients with cT2–4a, cN0,cN+, M0 squamoce llular cancers of the tongue and the floor ofmouth. Reconstruc tions were performed by a variety of flaps includ-

ing ALT (52), DIEP (15), VRAM (7) Fibula free flap (19), radial forearm free flap (14) and myofascial pectora lis flap (7).

Results: We discuss our experience of this surgical technique with focus on the functional results of reconstru ctions performed in our patien ts. Oncologica l outcomes and long term follow ups are also discuss ed.

Conclusions : In our opinion, CTS is the gold standard primary treatmen t for cancers of the tongue and of the floor of mouth.

doi:10.1016/j.oraloncology.2013.03.083

OP076

Videoflouroscopic evalua tion of swallowi ng after glossecto my – Aprospect ive study Meera Priya a, R Jayakumar Menon b, Subrami a Iyer c, Krishnak umar Thanka ppan d

a Head and Neck Oncology Departme nt, Amrita Institute of Medical Sciences and Research Center, Cochin, India b Department of ENT, Kerala Institute of Medical Sciences, Trivandr um,India c Head and Neck Surgery and Reconstruct ion, Amrita Institute of Medical Sciences and Research Center, Cochin, India d Amrita Institute of Medical Sciences and Research Center, Cochin, India

Purpose: The swallowing deficits that result from oral or oropha- ryngeal resectio ns vary considerabl y depending on the site, exten- sion of the resection, and type of reconstructi on. Most patients will experien ce some degree of dysphagia despite the reconstructi veeffort. The purpose of this study was to characteriz e swallow ing dys- function in patients who underwent a glossecto my with flap recon- struction , to define the limits and the compens atory movemen tsusing video fluoroscopic analysis of swallow ing (VFS).

Methodolog y: A prospectiv e evaluation of 16 glossectomy patients (15 men and 1 women), aged 40–60 years, who underwent glossec- tomy with flap reconstru ction were volunteers. Videoflouroscopic swallow ing study (VFS) was carried out after a preliminary subjec- tive evaluati on. Recordi ngs were analysed and a comparis on of the swallow ing dysfunction s were made. During the videoflouroscopic recordings, the effective ness of different compen satory and rehabil- itative swallowing therapy techniques was tried.

Results: Patients who underwent a total glossectomy with laryn- geal preservat ion had an increase in oral transit time and stasis offood in the oral cavity, the pharynx. Patients who underwent a par- tial glossecto my (lateral border of tongue involveme nt only) had dif- ficulties with formation and antero-posteri or propulsio n of the bolus in the oral cavity. The stasis in the oral cavity/val leculae and oral transit delay was comparativ ely less, and was evident only with materi als of thicker consistenc ies. All patients benefited from reha- bilitative and compensatory swallowing manoeuvres .

Conclusions : Videofluoroscopic analysis of swallowing could char- acterize swallowing dysfunc tion in patients who underwent a glos- sectomy with flap reconstructi on. Videoflouroscopic analysis ofswallow ing is not only a mere diagnost ic tool but also a prognostic tool. Appropriate swallowing interventio n benefited the patients inregaining the swallowing function. Patients with total glossectom y(with involveme nt of base tongue) showed longer time for recovery than partial glossecto my patients.

doi:10.1016/j.oraloncology.2013.03.084

S34 Abstracts / Oral Oncology 49 (2013) S4–S79