Tratamiento de la disfagia y la disglosia tras glosectomía total y reconstrucción con colgajo libre fasciocutáneo anterolateral de muslo: a propósito de un caso

Oncological surgery in extensive lingual carcinoma lesions requires wide resection and reconstruction with a peripheral free flap. Free flaps can provide a fairly normal physical appearance but, due to the specialization of the tongue, it is not easy to restore its functionality. This compromises the dynamics of swallowing in the oral and transport phase and spoken communication. Conventional speech-language therapy requires an average of 3-12 months. We present the case of a 64-year-old man with lingual epidermoid carcinoma stage IVA (T4aN0M0) who underwent total glossectomy with marginal mandibulectomy of the symphysis, reconstruction with an anterolateral thigh fasciocutaneous free flap, and bilateral functional lymphadenectomy. The patient required tracheostomy and a nasogastric catheter for feeding. We evaluated the patient on the eighth postsurgical day and initiated rehabilitation of mechanical oropharyngeal dysphagia and dysglossia at the bedside. The objectives were to encourage labial seal, swallowing of saliva, handling of secretions, decannulation, breathing and speaking coordination, speech intelligibility, and safe and effective swallowing and to prevent complications and improve quality of life. The patient was able to communicate with his direct surrounding in the fifth session and was able to make an oral ingestion with a soft diet and thickened liquids in the eighth session. The nasogastric catheter was removed and the patient was sent home on the 20th postoperative day. We conclude that early and individualized speech-language therapy within a multidisciplinary team is indispensable to restore swallowing and speech, improving the patient's quality of life. In addition, this kind of intervention reduces social and healthcare costs.