Tongue cancer patients can swallow
a little easier, thanks to two innovative surgeons at
the University of Alberta. The duo has developed a new
technique that greatly improves the chances of regaining
proper tongue function after reconstructive surgery.
"Traditionally, surgical removal
of base of tongue cancer does not bode well for patients'
ability to swallow. By adding more bulk to the reconstructed
area, we've shown that up to 95% of patients maintain
adequate swallowing capability," said Dr Hadi Seikaly,
director of the otolaryngology division at the U of
A who co-invented the procedure. He and his colleague
Dr Jeff Harris have been developing a modification to
conventional base of tongue reconstructive surgery —
nicknamed the "beavertail" method — for the past
five years.
There are about 900 cases of tongue
or tonsil cancer diagnosed in Canada each year, the
main risk factors of which are smoking and alcohol consumption.
But in an alarming trend, the fastest-growing group
of new cases has neither risk factor. Dr Seikaly said
research is being done to determine what's behind the
increase.
BEAVERING
AWAY
The so-called "beavertail" method removes cancerous
tissue at the base or back of the tongue and replaces
it with a paddle of skin, fascia and fat — usually
from the wrist, just under the palm. An artery and vein
are also harvested and connected to healthy blood vessels
in the neck, improving the reconstructed tongue's resiliency
after either chemo- or radiotherapy. But Dr Seikaly
said that the standout feature of his method is the
"beavertail" of fat, which is rolled up on itself at
the base of the tongue and provides the necessary bulk
to direct food down the throat.
With the conventional treatment
method, developed over two decades ago, cancerous tissue
is replaced with a thinner layer of tissue, usually
from the forearm, but sometimes also from the thigh
or back. The surgery is generally followed-up with radiation
or chemotherapy, which tends to shrink and scar the
reconstructed portion of the tongue.
"The base of the tongue normally
acts as a piston, pushing food into the esophagus. What's
left at the back of a patient's throat after standard
treatment lacks the mass and mobility to allow proper
swallowing," said Dr Seikaly. Ultimately, patients end
up having to be fed via a gastric tube.
"The chances that a patient will
be able to return to their pre-surgery life after standard
treatment are minimal," said Dr Seikaly, adding that,
with the "beavertail" modification, "we've found a way
to give patients the best shot at a normal life."
GET
THE WORD OUT
According to the findings of a soon-to-be-published
study, led by surgical resident Dr Dan O'Connell, the
"beavertail" method was successful at maintaining adequate
swallowing ability in the 19 out of 20 patients who
completed the study. The findings were presented earlier
this year at the annual American Head and Neck Society
meeting in Chicago where the study won the title of
Best Resident Clinical Research Award. Physicians across
Canada and the US are starting to take notice.
"Between five and 10 otolaryngologists
from across Canada — in Halifax, Toronto and Sherbrooke,
Quebec — have been trained to perform this technique.
There are also a growing number of practitioners in
the US. Our hope is that, as we continue to demonstrate
our findings at medical conferences, interest will continue
to increase," said Dr Seikaly.
This isn't the first time Dr Seikaly
has been involved in a cutting edge treatment. In 2000,
he and another U of A colleague, Dr Naresh Jha, developed
a surgical treatment that preserved salivary function
— and thus, a patient's sense of taste as well
as their teeth — after radiation therapy. The procedure
moves saliva glands from the middle of the jaw to the
front of the mouth, near the chin, and out of the way
of damaging radiation.
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