Background: Achieving optimal functional speech outcomes is essential in tongue reconstruction. Variables such as recipient artery, tumor size, and radiotherapy can impact tongue movement and speech outcome. Various tongue resection types and reconstruction methods exist. Our study examined post-hemiglossectomy speech outcomes by considering the reconstruction type and other relevant factors.

Methods: This retrospective study included 24 patients who underwent hemi-tongue reconstruction and speech rehabilitation. The evaluation included articulation, intelligibility, and specific syllabic challenges. Speech recordings and assessments were conducted in a controlled environment. Tongue movement and articulation were evaluated, and a speech therapist scored the intelligibility.

Results: In the 24 patients (mean age 53.3 years), hemi-tongue reconstruction with different flaps was performed. Elevation significantly impacted articulation (r = 0.621, p = 0.001) and intelligibility (r = 0.447, p = 0.029). Additionally, difficulties with the Korean /ㄹ/ sound (equivalent to /l/ or /r/ in English) were associated with elevation (r = -0.581, p = 0.003, 0: normal, 1: abnormal). In the multivariate regression analysis, elevation was found to be the significant factor influencing the difficulty in pronouncing the specific syllable /ㄹ/ (B=-0.059, OR=0.943, 95% confidence interval=0.902-0.986, p = 0.009). Mean articulation score was 89.3% (standard deviation 9.5). Intelligibility scores indicated that the speech was more than understandable in 91.6% of cases.

Conclusions: Favorable speech outcomes were observed post-hemiglossectomy with free flap reconstruction. Enhanced elevation functions led to the initial improvement of specific syllable (/ㄹ/) difficulties, with no observed challenges in pronouncing the /ㄹ/ sound during the follow-up period.