Background: Reinnerveration of free flaps used in oral and oropharyngeal reconstruction may provide a high level of sensory return. Spontaneous recovery of sensation in noninnervated flaps may also occur.
Objective: To evaluate the extent of spontaneous sensory return among patients who underwent radial forearm free flap reconstruction in the oral cavity and oropharynx.
Methods: A total of 40 patients were evaluated by 2 independent examiners. The median patient age was 60 years, and the median time from surgery was 47 months. A total of 29 patients had received postoperative radiotherapy. The mean flap size was 25 cm2. The following sensory modalities were tested: light touch, pinprick, hot and cold, and moving and static 2-point discrimination.
Results: Recovery of sensation of at least 1 modality was noted in 32 patients (80%), however, only 5 patients (13%) had return of all 5 modalities. Eight patients (20%) had no sensory return. There was a trend to improved sensory recovery in flaps placed in the alveolar and retromolar trigone areas; however, on multivariate analysis, sensory return could not be predicted by any of the following factors: patient age, flap site, flap size, length of follow-up, and use of postoperative radiotherapy.
Conclusions: Complete sensory recovery was uncommon, unpredictable, and variable, although some recovery of sensation occurred in 80% of patients. It is not valid to rely on spontaneous sensory recovery for sensory innervation of free flaps. Correlation of sensory return with function is still needed.