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Deng W, Zhao G, Li Z, Yang L, Xiao Y, Zhang S, Guo K, Xie C, Liang Y, Liao G. Recovery pattern analysis of swallowing function in patients undergoing total glossectomy and hemiglossectomy. Oral Oncol 2022; 132:105981. [PMID: 35752136 DOI: 10.1016/j.oraloncology.2022.105981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/27/2022] [Accepted: 06/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the recovery process of swallowing function and ascertain swallowing pattern in patients undergoing total glossectomy (TG). MATERIALS AND METHODS A cohort study was conducted in consecutive patients with tongue squamous cell carcinoma who received TG/hemiglossectomy (HG) from May 2017 to December 2019. Exposure factors included tongue resection range (HG and TG) and postoperative radiotherapy (PRT and non-PRT). The swallowing functions were evaluated by M.D. Anderson dysphagia inventory (MDADI), water swallow test (WST), and tongue pressure (TP) at pretreatment, 1, 4, 7, 12, 18 and 24 months postoperatively. Videofluoroscopy swallowing study (VFSS) was applied to analyze swallowing pattern of TG patients. RESULTS A total of 67 patients were enrolled, of which 17 underwent TG and 50 underwent HG. Both MDADI and TP of the TG and PRT group were lower than those of the HG and non-PRT group. TG patients had no evident improvement in MDADI and TP after surgery. There was a higher risk of swallowing unsafety with abnormal WST outcome in TG (P < 0.001, OR = 106.52) than that in HG. VFSS analysis identified prolonged oral and pharyngeal transit time, disorganized swallowing sequence, abnormal hyoid bone movement, and frequent invalid swallows in patients with TG. A shortened OTT (<5066.50 ms) and a larger pharyngeal constriction ratio (PCR > 0.31) were associated with increased risks of penetration and aspiration. CONCLUSION Postoperative swallowing pattern is a characteristic of severely impaired safety and efficacy in patients with TG. Impaired OTT and PCR are variables that should be examined when determining the need for rehabilitation treatment.
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Affiliation(s)
- Wei Deng
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Guiyi Zhao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Zhengshi Li
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Le Yang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Yudong Xiao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Sien Zhang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Kaixin Guo
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Chunqing Xie
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Yujie Liang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Guiqing Liao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
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Ohkubo M, Sugiyama T, Ohira M, Yamamoto M, Iguchi T, Shibahara T, Takano N, Ishida R. Swallowing Rehabilitation Affects Period of Hospitalization after Surgery for Tongue Cancer. THE BULLETIN OF TOKYO DENTAL COLLEGE 2017; 58:19-26. [PMID: 28381730 DOI: 10.2209/tdcpublication.2015-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Functional rehabilitation has been reported to improve swallowing. The effect of the presence or absence of such rehabilitation has yet to be compared in oral cancer patients, however. The purpose of this study was to investigate its effect on correlations between the period of hospitalization and the period of tube feeding (from the day of surgery to termination of tube feeding) and period of oral nutrition (from termination of tube feeding to discharge). Body weight was also measured on admission and discharge and the difference calculated. A correlation was observed between period of hospitalization and period of tube feeding in the rehabilitation group, and with the periods of tube feeding and oral nutrition in the non-rehabilitation group. In the rehabilitation group, the period of tube feeding appeared to affect period of hospitalization. On the other hand, termination of tube feeding did not tend to affect period of hospitalization. These results suggest that both periods were factors affecting period of hospitalization in the non-rehabilitation group. Not performing swallowing rehabilitation, therefore, resulted in the period of oral nutrition affecting the period of hospitalization. This suggests that it is essential that nutrients be ingested in moderation after termination of tube feeding, when they are only taken orally. Moreover, these results also indicate that rehabilitation is important in improving quality of life after discharge.
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Affiliation(s)
- Mai Ohkubo
- Department of Oral Health and Clinical Science, Division of Dysphagia Rehabilitation, Tokyo Dental College
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Sia I, Carvajal P, Lacy AA, Carnaby GD, Crary MA. Hyoid and laryngeal excursion kinematics - magnitude, duration and velocity - changes following successful exercise-based dysphagia rehabilitation: MDTP. J Oral Rehabil 2014; 42:331-9. [PMID: 25488830 DOI: 10.1111/joor.12259] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2014] [Indexed: 11/30/2022]
Abstract
Variability in magnitude of deglutitional hyolaryngeal excursion in patients with dysphagia suggests that it does not adequately represent the kinematics of swallowing difficulties or recovery following rehabilitation. On the other hand, reduced hyolaryngeal excursion velocity has been reported in patients with dysphagia. While increased movement velocity often accompanies clinical and functional recovery in many diseases, velocity changes in swallowing-related movement following dysphagia therapy have not been well studied. This study evaluated changes in hyoid and laryngeal excursion (magnitude, duration and velocity) before and following successful dysphagia therapy to provide a more comprehensive representation of improvement to swallowing kinematics in patients who have experienced successful rehabilitation. A secondary analysis of case series data was completed. Eight patients with severe, chronic dysphagia completed a standard course of an exercise-based dysphagia treatment programme (McNeill dysphagia therapy program, MDTP). Pre- and post-treatment, kinematic aspects of swallowing were evaluated for thin liquid, thick liquid and pudding swallows. Maximum hyoid and laryngeal excursion magnitude and excursion duration were measured. Excursion velocities were calculated from excursion magnitude and duration measures. Successful treatment for dysphagia facilitated increased hyolaryngeal excursion magnitude, duration and velocity. These changes were most prominent for the hyoid and most often observed with thin liquids. By examining hyoid and laryngeal excursion velocity in patients who have experienced successful dysphagia rehabilitation, this study demonstrated the value of evaluating spatial and temporal aspects of swallowing kinematics in a single measure for a more comprehensive representation of positive changes underlying functional recovery.
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Affiliation(s)
- I Sia
- Swallow Research Laboratory, Department of Speech, Language, and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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Quality of life after free-flap tongue reconstruction. The Journal of Laryngology & Otology 2008; 123:550-4. [DOI: 10.1017/s0022215108003629] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AbstractObjective:To analyse correlations between quality of life measures, aspiration and extent of surgical resection in patients who have undergone free-flap tongue reconstruction.Patients and methods:Nine consecutive patients (seven men and two women; average age 51 years) who had been diagnosed with T4a carcinoma of the mobile tongue and/or tongue base and treated by glossectomy, free-flap reconstruction, and either radiation therapy or chemoradiation responded to the European Organization for Research and Treatment of Cancer Head and Neck-35 questionnaire, the performance status scale questionnaire and the hospital anxiety–depression scale questionnaire, an average of 43 months after treatment (range 18–83 months). Aspiration was evaluated by fibre-optic laryngoscopy. Correlations between quality of life domain scores, extent of surgery and the presence of aspiration were evaluated using non-parametric statistical analysis.Results:Scores for the swallowing and aspiration domains of the European Organization for Research and Treatment of Cancer Head and Neck-35 questionnaire were significantly correlated with the extent of tongue base resection (Spearman's correlation, p = 0.037 and 0.042, respectively). Despite a strong correlation between the European Organization for Research and Treatment of Cancer Head and Neck-35 questionnaire results and the performance status scale global scores (correlation coefficient = 0.89, p = 0.048), the performance status scale domain scores were not correlated with the extent of tongue resection. Clinically apparent aspiration was not correlated with the extent of tongue resection, nor were the anxiety or depression scores. However, clinically apparent aspiration was significantly related to the swallowing and aspiration domain scores of the European Organization for Research and Treatment of Cancer Head and Neck-35 questionnaire (p = 0.017 in both cases).Conclusions:Our results imply that the volume of tongue base resection is a major factor in swallowing- and aspiration-related quality of life following tongue resection and free-flap reconstruction. Free-flap reconstruction does not seem to palliate the effect of the loss of functional tongue base volume, as regards swallowing-related quality of life.
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Hsiao HT, Leu YS, Chang SH, Lee JT. Swallowing function in patients who underwent hemiglossectomy: comparison of primary closure and free radial forearm flap reconstruction with videofluoroscopy. Ann Plast Surg 2003; 50:450-5. [PMID: 12792531 DOI: 10.1097/01.sap.0000044147.09310.e8] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The swallowing function of patients who had undergone hemiglossectomy with either primary closure of the defect or radial forearm flap reconstruction was studied with videofluoroscopy. Patients with primary closure were unable to lift the tongue tip, had poor tongue-to-palate contact on initiating swallowing, had premature spilling of the bolus into the pharynx, had a large amount of barium stasis on the floor of the mouth, and had prolonged oral transit time. With flap reconstruction, patients easily could lift the tongue and make good contact with the entire palate. They were able to seal the posterior pharyngeal sphincter by elevation of the reconstructed tongue, approximating it to the soft palate, so that premature spilling of the bolus rarely happened. Their swallowing pattern was nearly normal. Although the reconstructed flap is nonfunctional, it provides bulk and helps the remaining tongue to complete the swallow. Compared with primary closure of the tongue defect, the authors suggest it is better to reconstruct it with a free radial forearm flap when more than 50% of the tongue is resected.
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Affiliation(s)
- Hung-Tao Hsiao
- Department of Plastic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
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Hsiao HT, Leu YS, Lin CC. Primary closure versus radial forearm flap reconstruction after hemiglossectomy: functional assessment of swallowing and speech. Ann Plast Surg 2002; 49:612-6. [PMID: 12461444 DOI: 10.1097/00000637-200212000-00010] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors compared the postoperative speech and swallowing function of six patients who underwent free radial forearm flap reconstruction after hemiglossectomy with that of six control patients who underwent primary closure of the defect. Clinical speech pathologic evaluations included the Fletcher time-to-time maximum repetition rate of syllables, multiple rhyme test, and overall quality and intelligibility of the patients' speech. Evaluation of swallowing included the duration of deglutition, bolus volume, and ingestion rate. Speech quality, including intelligibility and articulation, was better in patients with primary closure. However, the bolus volume and ingestion rate in deglutition were better in those with flap reconstruction. These results suggest that the flap adds bulk, thus improving pharyngeal clearance by maintaining the tongue-to-mouth roof contact that is necessary in the swallowing process. The nonfunctional flap, however, hinders articulation by restricting the mobility of the remaining portion of the normal tongue.
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Affiliation(s)
- Hung-Tao Hsiao
- Department of Plastic and Reconstructive Surgery, Mackay Memorial Hospital, 92 Chung-San North Road, section 2, Taipei, Taiwan
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Bussi M, Valente G, Curato MP, Carlevato MT, Cortesina G. Is transposed skin transformed in major head and neck mucosal reconstruction? Acta Otolaryngol 1995; 115:348-51. [PMID: 7610839 DOI: 10.3109/00016489509139327] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We used histological and histochemical methods to investigate the possible changes with time in skin transposed into the oropharynx and oral cavity of patients whose surgical wounds were reconstructed with the classic pectoralis major flap. We found histological evidence that skin morphology was maintained (keratinization with reduced, but the desquamating layer, hair follicles, sweat and sebaceous glands were identifiable), and noted an intense inflammatory reaction in the dermis. Histochemical studies confirmed the progressive flattening of the basal interdigitations between the epithelium and dermis, and the gradual reconstruction of the basement membrane. Although skin-mucosa continuity developed fairly quickly without scar reactions, the two epithelia maintained their original patterns of keratin production, i.e., their textural peculiarities. We propose an original method for the transposition of muscular flaps implanted with autologous culture of keratinocytes, an approach developed in an attempt to ensure more satisfactory rehabilitation of the removed mucosal structures.
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Affiliation(s)
- M Bussi
- II ENT Department, University of Turin, Italy
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Stachler RJ, Hamlet SL, Mathog RH, Jones L, Heilbrun LK, Manov LJ, O'Campo JM. Swallowing of bolus types by postsurgical head and neck cancer patients. Head Neck 1994; 16:413-9. [PMID: 7960738 DOI: 10.1002/hed.2880160504] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Clinically, head and neck cancer patients with anterior resections have better postoperative outcomes than do patients with posterior resections. METHODS Videofluoroscopy was used to study the swallowing characteristics in postsurgery head and neck cancer patients and normal controls. Most patients received post-operative radiotherapy and chemotherapy, and no cancer recurrence was noted at the time of study, 4-8 months posttreatment. Bolus types included: 3 mL and 10 mL liquid barium, barium paste, and barium-coated cookie. Temporal measurements and a count of the number of swallows required to ingest each material were made from the videotaped data. Statistical analysis using an unbalanced univariate repeated measures ANOVA was performed. RESULTS The major differences were found between bolus types, with few differences noted between surgical groups (anterior vs posterior resections) and normal controls. Patients took longer to ingest viscous material, accomplishing this by multiple piecemeal and clearing swallows. Coordination of mastication and swallowing of the cookie was different between normal and patient groups. CONCLUSIONS Patients who are able to swallow reasonably well postoperatively maintain normal coordination and timing of swallowing activity and do not vary these parameters to compensate for structural inadequacy. Instead, repeated swallows are used.
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Affiliation(s)
- R J Stachler
- Department of Otolaryngology, Wayne State University, Detroit, Michigan
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