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Han X, Bai Z, Mogushi K, Hase T, Takeuchi K, Iida Y, Sumita YI, Wakabayashi N. Machine Learning Prediction of Tongue Pressure in Elderly Patients with Head and Neck Tumor: A Cross-Sectional Study. J Clin Med 2024; 13:2363. [PMID: 38673635 PMCID: PMC11051183 DOI: 10.3390/jcm13082363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Background: This investigation sought to cross validate the predictors of tongue pressure recovery in elderly patients' post-treatment for head and neck tumors, leveraging advanced machine learning techniques. Methods: By employing logistic regression, support vector regression, random forest, and extreme gradient boosting, the study analyzed an array of variables including patient demographics, surgery types, dental health status, and age, drawn from comprehensive medical records and direct tongue pressure assessments. Results: Among the models, logistic regression emerged as the most effective, demonstrating an accuracy of 0.630 [95% confidence interval (CI): 0.370-0.778], F1 score of 0.688 [95% confidence interval (CI): 0.435-0.853], precision of 0.611 [95% confidence interval (CI): 0.313-0.801], recall of 0.786 [95% confidence interval (CI): 0.413-0.938] and an area under the receiver operating characteristic curve of 0.626 [95% confidence interval (CI): 0.409-0.806]. This model distinctly highlighted the significance of glossectomy (p = 0.039), the presence of functional teeth (p = 0.043), and the patient's age (p = 0.044) as pivotal factors influencing tongue pressure, setting the threshold for statistical significance at p < 0.05. Conclusions: The analysis underscored the critical role of glossectomy, the presence of functional natural teeth, and age as determinants of tongue pressure in logistics regression, with the presence of natural teeth and the tumor site located in the tongue consistently emerging as the key predictors across all computational models employed in this study.
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Affiliation(s)
- Xuewei Han
- Department of Advanced Prosthodontics, Graduate School, Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 1138510, Japan; (X.H.); (Z.B.); (N.W.)
| | - Ziyi Bai
- Department of Advanced Prosthodontics, Graduate School, Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 1138510, Japan; (X.H.); (Z.B.); (N.W.)
| | - Kaoru Mogushi
- Institute of Education, Tokyo Medical and Dental University, Tokyo 1138510, Japan; (K.M.); (T.H.)
| | - Takeshi Hase
- Institute of Education, Tokyo Medical and Dental University, Tokyo 1138510, Japan; (K.M.); (T.H.)
- Faculty of Pharmacy, Keio University, Tokyo 1088345, Japan
- Center for Mathematical Modelling and Data Science, Osaka University, Osaka 5608531, Japan
- The Systems Biology Institute, Tokyo 1410022, Japan
| | - Katsuyuki Takeuchi
- Institute of Education, Tokyo Medical and Dental University, Tokyo 1138510, Japan; (K.M.); (T.H.)
| | - Yoritsugu Iida
- Institute of Education, Tokyo Medical and Dental University, Tokyo 1138510, Japan; (K.M.); (T.H.)
| | - Yuka I. Sumita
- Department of Advanced Prosthodontics, Graduate School, Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 1138510, Japan; (X.H.); (Z.B.); (N.W.)
- Department of Partial and Complete Denture, The Nippon Dental University School of Life Dentistry, Tokyo 1028159, Japan
| | - Noriyuki Wakabayashi
- Department of Advanced Prosthodontics, Graduate School, Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 1138510, Japan; (X.H.); (Z.B.); (N.W.)
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Chiba T, Izumita K, Koyama S, Sato N, Tagaino R, Hatakeyama T, Sasaki K. Effects of maxillofacial prosthetic treatment on oral health-related quality of life and masticatory ability of patients with head and neck tumors. J Oral Sci 2024; 66:30-36. [PMID: 38030286 DOI: 10.2334/josnusd.23-0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
PURPOSE Using multivariate analysis, this study investigated the effectiveness of maxillofacial prosthetic treatment in relation to oral health-related quality of life (OHR-QoL), masticatory ability (food intake status score and gum-jelly test score) and related factors in patients who had undergone surgery for head and neck tumors. METHODS The study cohort comprised 112 patients who underwent surgical resection and prosthetic treatment among 224 patients with head and neck tumors seen at the Maxillofacial Prosthetics Clinic of Tohoku University Hospital in a 2-year period. Correlations between OHR-QoL, food intake status score, and gum-jelly test score (criterion variables), and age, sex, maxillary defect, tongue/soft tissue defect, reconstructive surgery, and chemoradiotherapy (explanatory variables) were investigated, and the data were examined statistically. RESULTS Maxillary defect, tongue and soft palate tissue defect, and chemoradiotherapy were identified as factors that hindered the effectiveness of maxillofacial prosthetic treatment for improvement of the OHR-QoL, food intake status score, and gum-jelly test score. On the other hand, reconstructive surgery was a factor that facilitated the improvement of OHR-QoL and masticatory ability with maxillofacial prosthetic treatment. CONCLUSION The factors identified to be related to the success or failure of maxillofacial prosthetic treatment suggest the importance of combining prosthetic intervention with surgical reconstruction.
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Affiliation(s)
- Takahiro Chiba
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry
| | | | - Shigeto Koyama
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital
| | - Naoko Sato
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital
| | - Ryo Tagaino
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital
| | | | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry
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Pavlidou E, Kyrgidis A, Vachtsevanos K, Constantinidis J, Triaridis S, Printza A. Efficacy of High-Intensity Training in Patients with Moderate to Severe Dysphagia after Glossectomy. J Clin Med 2023; 12:5613. [PMID: 37685680 PMCID: PMC10488737 DOI: 10.3390/jcm12175613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Dysphagia is the main impairment arising from glossectomy for tongue cancer treatment. The study aimed to determine if an eight-week training protocol paired with accuracy tasks and swallowing exercises is effective and can improve tongue strength and swallowing in patients after tongue resection. Maximum isometric pressures, tongue endurance, swallowing pressures, mealtime duration, and oropharyngeal swallow function were studied in patients with moderate to severe dysphagia after glossectomy. Twenty-five (25) patients and thirty-one (31) healthy participants were enrolled in the study. The therapy group (TG) consisted of seventeen (17) patients who followed an 8-week treatment protocol and had multiple measurements. The follow-up control group (FUG) consisted of eight non-treated patients who had a baseline and an 8-week follow-up examination. Healthy participants served as the reference group (RF). Maximum isometric pressures, endurance, and swallowing pressures increased significantly in the TG versus the FUG. Significant improvement was documented in the TG regarding the EAT-10 questionnaire, the Penetration-Aspiration Scale scores at thickened and solid boluses, and post-swallow residues at thickened and solid boluses. The treatment protocol with tongue strength exercises combined with accuracy tasks and swallowing exercises improves the post-operative swallowing function in patients after glossectomy. Patients in the TG had more significant and quicker improvement in pressures and endurance compared to FUG.
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Affiliation(s)
- Elena Pavlidou
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
| | - Athanasios Kyrgidis
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (A.K.); (K.V.)
| | - Konstantinos Vachtsevanos
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (A.K.); (K.V.)
| | - Jannis Constantinidis
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
| | - Stefanos Triaridis
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
| | - Athanasia Printza
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
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Perioperative Decrease in Tongue Pressure is an Intervenable Predictor of Aspiration After Esophagectomy. Dysphagia 2022:10.1007/s00455-022-10541-2. [DOI: 10.1007/s00455-022-10541-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
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Ihara Y, Kato H, Tashimo Y, Iizumi Y, Fukunishi Y, Sato H, Shimane T, Takahashi K. Changes in oral function, swallowing function, and quality of life in patients with head and neck cancer: a prospective cohort study. BMC Oral Health 2022; 22:293. [PMID: 35843950 PMCID: PMC9288711 DOI: 10.1186/s12903-022-02329-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background Head and neck cancer (HNC) treatment can cause oral morbidities, such as oral dryness and dysphagia, affecting the patient’s quality of life (QOL). The relationship between oral functions and QOL in patients with early-stage HNC remains poorly studied. This study aimed to evaluate changes in the QOL of patients with early-stage HNC and identify factors that affect the QOL of these patients. Methods In this prospective cohort study, 37 patients who underwent early-stage (Stage I/Stage II) HNC treatment were evaluated for their oral function, swallowing function, and the QOL score at baseline (BL) and 12 months after surgical treatment (12 M). The participants were divided into two groups: patients who returned to the BL QOL score at 12 M (RE; n = 26) and those who did not (NR; n = 11). Results In total, 29.7% (11/37) patients with early-stage HNC did not return to the BL QOL score at 12 M. There was no significant difference between the RE and NR groups regarding the oral and swallowing function. Moreover, oral and swallowing function of all patients returned to the BL at 12 M. The NR group showed lower QOL scores than the RE group in the global health status, and “sticky saliva” parameters in the questionnaires. Conclusion Restoration of the oral function is insufficient to improve the QOL of patients with early-stage HNC. The treatment of these patients should instead consider several factors that affect their QOL.
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Comparison of Tongue Characteristics Classified According to Ultrasonographic Features Using a K-Means Clustering Algorithm. Diagnostics (Basel) 2022; 12:diagnostics12020264. [PMID: 35204355 PMCID: PMC8870935 DOI: 10.3390/diagnostics12020264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022] Open
Abstract
The precise correlations among tongue function and characteristics remain unknown, and no previous studies have attempted machine learning-based classification of tongue ultrasonography findings. This cross-sectional observational study aimed to investigate relationships among tongue characteristics and function by classifying ultrasound images of the tongue using a K-means clustering algorithm. During 2017–2018, 236 healthy older participants (mean age 70.8 ± 5.4 years) were enrolled. The optimal number of clusters determined by the elbow method was 3. After analysis of tongue thickness and echo intensity plots, tongues were classified into three groups. One-way ANOVA was used to compare tongue function, tongue pressure, and oral diadochokinesis for /ta/ and /ka/ in each group. There were significant differences in all tongue functions among the three groups. The worst function was observed in patients with the lowest values for tongue thickness and echo intensity (tongue pressure [P = 0.023], /ta/ [P = 0.007], and /ka/ [P = 0.038]). Our results indicate that ultrasonographic classification of tongue characteristics using K-means clustering may aid clinicians in selecting the appropriate treatment strategy. Indeed, ultrasonography is advantageous in that it provides real-time imaging that is non-invasive, which can improve patient follow-up both in the clinic and at home.
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Hasegawa Y, Tsuji S, Nagai K, Sakuramoto-Sadakane A, Tamaoka J, Oshitani M, Ono T, Sawada T, Shinmura K, Kishimoto H. The relationship between bone density and the oral function in older adults: a cross-sectional observational study. BMC Geriatr 2021; 21:591. [PMID: 34686146 PMCID: PMC8539774 DOI: 10.1186/s12877-021-02547-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Falls among older adults with a low bone density can lead to a bedridden state. Declining bone density increases the risk of falls resulting fractures in older adults. A person's physical performance is known to be closely related to bone density, and a relationship between the physical performance and the oral function is also known to exist. However, there currently is a lack of evidence regarding the relationship between bone density and the oral function. We assessed the relationship between the bone density and the both the oral function and physical performance among older adults. PATIENTS AND METHODS 754 older adults aged 65 years or older who independently lived in rural regions and who were not taking any medications for osteoporosis participated. We checked all participants for osteoporosis using an ultrasonic bone density measuring device. Regarding the oral function, we evaluated the following factors: remaining teeth, occlusal support, masticatory performance, occlusal force, and tongue pressure. We also evaluated body mass index (BMI) and skeletal muscle mass Index as clinical characteristics. The normal walking speed, knee extension force and one-leg standing test were evaluated as physical performance. For the statistical analyses, we used the Mann-Whitney U test, chi-square test, the Kruskal-Wallis, and a multiple regression analysis. RESULTS Eighty-one percent of the females and 58% of the males had osteoporosis or a decreased bone mass. The occlusal force, masticatory performance and the tongue pressure showed significant association with the bone density. The participants physical performance showed a significant association with their bone states except for walking speed. According to a multiple regression analysis, clinical characteristics (sex, age, BMI), one-leg standing and occlusal force showed independent associations with the bone density. It was suggested that the bone density tends to increase if the occlusal force is high and/or the one-leg standing test results are good. CONCLUSIONS The bone density in the older adults showed a significant relationship not only with clinical characteristics or physical performance, but also with occlusal force. It may also be effective to confirm a good oral function in order to maintain healthy living for older adults.
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Affiliation(s)
- Yoko Hasegawa
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo Japan
- Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, 5274, Gakkocho-dori 2-bancho, Chuo-ku, Niigata, 951-8514 Japan
| | - Shotaro Tsuji
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Koutatsu Nagai
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, 1-3-6 Minatojima, Chuo-ku, Kobe, Hyogo Japan
| | - Ayumi Sakuramoto-Sadakane
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Joji Tamaoka
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Masayuki Oshitani
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Takahiro Ono
- Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, 5274, Gakkocho-dori 2-bancho, Chuo-ku, Niigata, 951-8514 Japan
| | - Takashi Sawada
- Hyogo Dental Association, 5-7-18 Yamamoto-dori, Chuo-ku, Kobe, Hyogo Japan
| | - Ken Shinmura
- Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Hiromitsu Kishimoto
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo Japan
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Kuniyuki I, Hisaoka T, Ikeda R, Suzuki J, Sato N, Tagaino R, Kambayashi T, Hirano-Kawamoto A, Ohta J, Ohkoshi A, Ishii R, Shitraishi N, Kato K, Koyama S, Sasaki K, Katori Y. Changes in tongue pressure and dysphagia at oral cancer patients by palatal augmentation prosthesis. Cancer Rep (Hoboken) 2021; 5:e1516. [PMID: 34472726 PMCID: PMC9327658 DOI: 10.1002/cnr2.1516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/31/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background The palatal augmentation prosthesis (PAP) is an intraoral prosthesis used in the treatment of dysphagia. Aim The objective of the study is to examine the effect of PAP using tongue pressure and the Videofluoroscopic Dysphagia Scale (VDS) to understand the precise mechanism for improvement in swallowing function with PAP for oral cancer at retrospective survey. Methods and results Fifteen patients were provided PAPs. Tongue pressure and VDS were evaluated with and without PAP. After intervention with PAP, tongue pressure significantly increased as compared to when without PAP (p < .05). The total mean VDS score with PAP was found to have significantly improved (p < .05). The mean VDS score of the oral phase also significantly improved with the PAP compared to without the PAP group (p < .05). Significant differences (p < .01) were found in each category, such as tongue to palate contact and pyriform sinus residue. Conclusion PAP can improve tongue pressure, tongue to palate contact, and pyriform sinus residue.
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Affiliation(s)
- Izumita Kuniyuki
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital, Sendai, Japan
| | - Takuma Hisaoka
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Suzuki
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoko Sato
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital, Sendai, Japan
| | - Ryo Tagaino
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital, Sendai, Japan
| | - Tomonori Kambayashi
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ai Hirano-Kawamoto
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Ohta
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryo Ishii
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naru Shitraishi
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Kengo Kato
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigeto Koyama
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital, Sendai, Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Change in Nutritional Status and Dysphagia after Resection of Head and Neck Cancer. Nutrients 2021; 13:nu13072438. [PMID: 34371947 PMCID: PMC8308483 DOI: 10.3390/nu13072438] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 01/18/2023] Open
Abstract
Nutritional status is well-known to influence patient recovery after resection of head and neck cancer (HNC). The influence of preoperative nutritional status on dysphagia was assessed in patients who underwent surgical resection of HNC along with the assessment of nutritional status during the acute and subacute phases. Eighty-six patients underwent surgical resection and dysphagia assessments (repetitive saliva-swallowing test, water-swallowing test, and functional oral intake scale) and had their tongue pressure assessed five times (before surgery, after 1–2 weeks, and 1, 2, and 3 months after surgery). The nutritional status was assessed according to the body mass index, total protein, and albumin. The prognostic nutritional index was calculated from preoperative data, and the subjects were classified into three groups: Low-risk, Attention and High-risk groups. After surgery, the nutritional status index values were low, and the High-risk group showed significantly lower values in comparison to the other two groups. The water-swallowing test and functional oral intake scale findings were worse than they had been preoperatively until 2 months after surgery, and a significant correlation was noted between the postoperative nutritional status and the presence of dysphagia. The results indicated that the preoperative nutritional status of HNC patients influenced their ability to ingest/swallow, which in turn influenced their nutritional status after HNC resection.
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Yamaguchi K, Hara K, Nakagawa K, Yoshimi K, Ariya C, Nakane A, Furuya J, Tohara H. Ultrasonography Shows Age-related Changes and Related Factors in the Tongue and Suprahyoid Muscles. J Am Med Dir Assoc 2020; 22:766-772. [PMID: 33229307 DOI: 10.1016/j.jamda.2020.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/02/2020] [Accepted: 10/10/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To investigate age and other factors related to the deterioration of the muscles used for swallowing, including the tongue and suprahyoid muscles. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS This study included 146 participants: 47 younger adults (23 men and 24 women; age range 23-44 years) recruited from a dental hospital and 99 community-dwelling older adults (37 men and 62 women, age range 65-86 years). METHODS Age (<65 years or ≥65 years), body mass index (BMI), skeletal muscle mass index (SMI), and tooth loss (Eichner classification) were measured. The cross-sectional areas (CSAs) of the tongue, geniohyoid muscle, and anterior belly of the digastric muscle were measured using an ultrasonic diagnostic apparatus. The correlation between each muscle's CSA and strength was examined. Multiple regression analyses were performed separately for each sex using each muscle CSA as the dependent variable and age, BMI, SMI, and the Eichner classification as explanatory variables. RESULTS Older men had a significant positive correlation between tongue pressure and CSA (r = 0.35, P = .031). Jaw opening force was positively correlated with geniohyoid muscle CSA (r = 0.41, P = .001) in older women. In the multiple regression analysis, age, BMI, and SMI were significantly associated with tongue CSA in men. Age was significantly and inversely associated with suprahyoid muscle CSA in both men and women. No explanatory variables were significantly associated with geniohyoid muscle CSA except age. CONCLUSIONS AND IMPLICATIONS The tongue increased in volume, and the suprahyoid muscles underwent atrophy with age. The study results suggest that interventions to prevent dysphagia associated with aging should be tailored toward specific muscles. Direct muscle training is required for the suprahyoid muscles, whereas the maintenance of tongue muscle mass and function, as well as training for the tongue, requires attention to ensure optimal nutritional status and whole-body skeletal muscle mass.
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Affiliation(s)
- Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Koji Hara
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuharu Nakagawa
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kanako Yoshimi
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chantaramanee Ariya
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayako Nakane
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichi Furuya
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, Tokyo, Japan; Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo, Japan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, Tokyo, Japan
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Nagashima K, Kikutani T, Miyashita T, Yajima Y, Tamura F. Tongue muscle strength affects posterior pharyngeal wall advancement during swallowing: A cross-sectional study of outpatients with dysphagia. J Oral Rehabil 2020; 48:169-175. [PMID: 33112420 PMCID: PMC7983890 DOI: 10.1111/joor.13120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/17/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022]
Abstract
Background Tongue muscle strength is important for swallowing but decreases with age, in association with reduced skeletal muscle mass. However, the relationships between pharyngeal dynamics and both skeletal muscle mass and tongue muscle strength are unknown. Objective To investigate the effect of reductions in tongue muscle strength on pharyngeal movement during swallowing in patients with dysphagia. Methods Subjects were selected from male outpatients ≥65 years old who were examined for the main complaint of dysphagia. Patients with history of neurodegenerative disease affecting tongue movement, cerebrovascular disease or oral cancer were excluded. As a result, 82 men (mean age, 80.6 ± 6.8 years) participated. Skeletal muscle mass index (SMI) as physical parameters and maximum tongue pressure (MTP) as tongue muscles strength were measured. Status and dynamics of the pharyngeal organs, including change in posterior pharyngeal wall advancement (PPWA) when swallowing 3.0 mL of moderately thick liquid, were measured by analysing videofluoroscopic images. Simple bivariate correlation and multiple regression analysis were used to statistically analyse correlations between parameters. Results MTP showed a significant positive correlation with SMI (r = .43, P < .01). PPWA showed a significant negative correlation with MTP (r = −0.30, P < .01), but no association with SMI. Conclusions While tongue muscle strength is affected by skeletal muscle mass, posterior pharyngeal wall advancement is not readily affected by decreases in skeletal muscle mass. Posterior pharyngeal wall advancement may increase to compensate for swallowing function among individuals with reduced tongue muscle strength.
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Affiliation(s)
- Keigo Nagashima
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry, Tokyo, Japan
| | - Takeshi Kikutani
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry, Tokyo, Japan.,Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Tama Oral Rehabilitation Clinic, Tokyo, Japan.,Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo, Japan
| | - Taishi Miyashita
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry, Tokyo, Japan
| | - Yuri Yajima
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Tama Oral Rehabilitation Clinic, Tokyo, Japan
| | - Fumiyo Tamura
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Tama Oral Rehabilitation Clinic, Tokyo, Japan.,Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo, Japan
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12
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Validity of a dysphagia screening test following resection for head and neck cancer. Ir J Med Sci 2020; 190:67-77. [PMID: 32607911 DOI: 10.1007/s11845-020-02286-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the validity of a dysphagia screening test (DST) in patients who have undergone resection for head and neck cancer (HNC). In addition, we examined whether or not combined effects of DSTs improve the detection accuracy of penetration/aspiration. METHODS Thirty-six HNC patients were participated. The DST consisted of the repetitive saliva swallowing test (RSST), the water swallowing test (WST), the modified water swallowing test (MWST), the food test (FT), and tongue pressure. A videofluoroscopic swallowing study was conducted, and the penetration-aspiration scale was used for scoring. For statistical analyses, we used the receiver operating characteristic (ROC) analysis. Furthermore, the accuracy of the determination of penetration/aspiration was evaluated by combining two or three DSTs. RESULTS The penetration/aspiration could be predicted with moderate accuracy based on MWST and FT. The area under the ROC curve (AUC) values of the MWST and FT were 0.76 (p = 0.03) and 0.80 (p = 0.050), and the sensitivity/specificity was 0.9/0.61 (MWST) and 0.8/0.8 (FT), respectively. As a result of combining 2 or 3 DSTs, the combination of "MWST and FT" was the most accurate, with an AUC of 0.87 (p = 0.02). The combination of three tests had lower accuracy than the combination of two tests. CONCLUSION Based on our results, it is recommended that MWST or FT be used when only one type of DST is performed. In addition, the combination of two DSTs may detect aspiration patients more accurately than one alone.
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Yoshikawa M, Fukuoka T, Mori T, Hiraoka A, Higa C, Kuroki A, Takeda C, Maruyama M, Yoshida M, Tsuga K. Comparison of the Iowa Oral Performance Instrument and JMS tongue pressure measurement device. J Dent Sci 2020; 16:214-219. [PMID: 33384800 PMCID: PMC7770307 DOI: 10.1016/j.jds.2020.06.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background/purpose Tongue pressure measurement conveys important information about eating and swallowing function. The Iowa Oral Performance Instrument® (IOPI) and KAY Swallowing Workstation® are internationally used for tongue pressure measurement, but for legal reasons cannot be used in Japan; rather the JMS tongue pressure measurement device® has been approved for use in Japan. However, it is not clear whether measurement obtained with these devices are directly comparable. Materials and methods This study investigated the correlation between the maximum tongue pressure data measured by the IOPI and the JMS tongue pressure measurement device in young healthy participants (34 males; 23.2 ± 2.0 years old, and 40 females; 21.4 ± 1.3 years old). Results Measurements obtained with these two devices showed significant correlations in the total cohort, and in male and female participants, separately (P < 0.05). Conclusion These findings demonstrate that the measurements obtained with the JMS device is comparable to those obtained with the IOPI. In Japan, JMS tongue pressure measurement device is used not only in dysphagia research field, but also geriatrics field, and extensive and detailed investigations has been carried out.
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Affiliation(s)
- Mineka Yoshikawa
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
- Corresponding author. 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan. Fax: +81 92 257 5679.
| | - Tatsuyuki Fukuoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Japan
| | - Takahiro Mori
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Aya Hiraoka
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Chiaki Higa
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Azusa Kuroki
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Chiho Takeda
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Mariko Maruyama
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Mitsuyoshi Yoshida
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kazuhiro Tsuga
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
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Chantaramanee A, Tohara H, Nakagawa K, Hara K, Nakane A, Yamaguchi K, Yoshimi K, Junichi F, Minakuchi S. Association between echo intensity of the tongue and its thickness and function in elderly subjects. J Oral Rehabil 2019; 46:634-639. [PMID: 30869159 DOI: 10.1111/joor.12788] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/25/2019] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The tongue plays an important role during the oropharyngeal phase of swallowing. Each part of the tongue has a different function during swallowing. Ageing causes changes in muscle quantity and quality. Qualitative changes, such as an increase in intramuscular adipose tissue, can be determined by the echo intensity (EI) of the tongue on ultrasonography (US). OBJECTIVE To clarify the relationship between EI and thickness and function of the tongue. METHODS Ninety-four healthy elderly individuals (30 male, 64 female) aged >65 years (mean 71.10 ± 4.13 years) were enrolled. Tongue thickness (TT) and EI were determined by US. Tongue function was evaluated by measurement of tongue pressure and oral diadochokinesis (OD). Multiple regression analysis was used to identify the factor with the strongest influence on EI of the tongue. RESULTS The mean thickness of the middle of the tongue was 40.42 ± 4.24 mm and that of the base was 23.35 ± 3.32 mm; the respective EI values were 46.54 ± 9.33 and 49.33 ± 9.83. The average OD rates for /ta/ and /ka/ were 5.73 ± 1.09 and 5.40 ± 1.00 times/s, respectively. Multiple regression analysis for EI showed that /ta/ (β = -2.518, P = 0.042) and thickness of the middle of the tongue (β = -1.278, P < 0.001) were significant independent variables. Similarly, the EI at the base of the tongue showed that /ka/ (β = -4.038, P = 0.021) and base of TT (β = -0.913, P = 0.004) were significant independent variables. CONCLUSION EI may be an indicator of TT and OD in both the middle and base of the tongue. Ultrasound is beneficial for evaluating TT and function.
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Affiliation(s)
- Ariya Chantaramanee
- Department of Gerodontology, Division of Gerontology and Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Haruka Tohara
- Department of Gerodontology, Division of Gerontology and Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuharu Nakagawa
- Department of Gerodontology, Division of Gerontology and Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Hara
- Department of Gerodontology, Division of Gerontology and Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayako Nakane
- Department of Gerodontology, Division of Gerontology and Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kohei Yamaguchi
- Department of Gerodontology, Division of Gerontology and Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kanako Yoshimi
- Department of Gerodontology, Division of Gerontology and Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Furuya Junichi
- Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology, Division of Gerontology and Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
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Yano J, Yamamoto-Shimizu S, Yokoyama T, Kumakura I, Hanayama K, Tsubahara A. Effects of anterior tongue strengthening exercises on posterior tongue strength in healthy young adults. Arch Oral Biol 2019; 98:238-242. [DOI: 10.1016/j.archoralbio.2018.11.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 12/17/2022]
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Yu M, Gao X. Tongue pressure distribution of individual normal occlusions and exploration of related factors. J Oral Rehabil 2018; 46:249-256. [PMID: 30375017 PMCID: PMC7379747 DOI: 10.1111/joor.12741] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/18/2018] [Accepted: 10/24/2018] [Indexed: 02/02/2023]
Abstract
Background Tongue plays an important part in oral and maxillofacial system. Measurement of tongue pressure helps to evaluate the performance of tongue movement. Objectives To establish a system for measuring tongue pressure against hard palate and to preliminarily explore pressure distribution of individual normal occlusions and the relationship with dental arch form. Methods A total of 19 volunteers of individual normal occlusions out of 189 dental students met inclusion criteria (nine males, ten females, aged 25.53 ± 0.96 years). A force‐sensing resistor device was used to measure tongue pressure at rest and functional state (swallowing). We observed tongue pressure of four channel (anterior, posterior and lateral sides of hard palate) in sitting, supine position and swallowing. We analysed pressure differences according to gender and explored correlation relationship between tongue pressure and dental arch width and length using 3D digital maxillary image. Results In rest, tongue pressure against hard palate increased from front to back in both sitting and supine position, without gender differences. When swallowing saliva, the pressure at lateral sides of females was found significantly higher than that of males. Bivariate correlation analysis revealed duration of swallowing was positively correlated with BMI and weight at posterior region and positively correlated with palatal length at anterior palate. The greater the dental arch width, the smaller the pressure of swallowing in the anterior and lateral region. Conclusion In rest, there was consistent pressure of tongue against hard palate. The pressure increased significantly during swallowing, especially in females. Tongue pressure was related to dental arch length, width, BMI and weight.
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Affiliation(s)
- Min Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
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Minakuchi S, Tsuga K, Ikebe K, Ueda T, Tamura F, Nagao K, Furuya J, Matsuo K, Yamamoto K, Kanazawa M, Watanabe Y, Hirano H, Kikutani T, Sakurai K. Oral hypofunction in the older population: Position paper of the Japanese Society of Gerodontology in 2016. Gerodontology 2018; 35:317-324. [PMID: 29882364 DOI: 10.1111/ger.12347] [Citation(s) in RCA: 240] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is growing international interest in identifying the effects of ageing on oral health and on appropriate strategies for managing oral disorders. The Japanese Society of Gerodontology (JSG), as the official representative of researchers and clinicians interested in geriatric dentistry in Japan, makes several recommendations on the concept of "oral hypofunction." AIMS This study proposes diagnostic criteria and management strategies to reduce the risk of oral hypofunction among older people. CONCEPTUAL FRAMEWORK We define oral hypofunction as a presentation of 7 oral signs or symptoms: oral uncleanness; oral dryness; decline in occlusal force; decline in motor function of tongue and lips; decline in tongue pressure; decline in chewing function; and decline in swallowing function. The criteria of each symptom were determined based on the data of previous studies, and oral hypofunction was diagnosed if the criteria for 3 or more signs or symptoms were met. CONCLUSIONS We recommend that more evidence should be gathered from clinical studies and trials to clarify our diagnostic criteria and management strategies.
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Affiliation(s)
- Shunsuke Minakuchi
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuhiro Tsuga
- Department of Advanced Prosthodontics, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazunori Ikebe
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Takayuki Ueda
- Department of Removable Prosthodontics & Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Fumiyo Tamura
- Tama Oral Rehabilitation Clinic, The Nippon Dental University, Tokyo, Japan
| | - Kan Nagao
- Department of Oral & Maxillofacial Prosthodontics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Junichi Furuya
- Department of Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichiro Matsuo
- Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Ken Yamamoto
- Department of Community Dentistry, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Manabu Kanazawa
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yutaka Watanabe
- Research on Social and Human Sciences, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Dentistry and Oral Surgery, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takeshi Kikutani
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry at Tokyo, Tokyo, Japan
| | - Kaoru Sakurai
- Department of Removable Prosthodontics & Gerodontology, Tokyo Dental College, Tokyo, Japan
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Hasegawa Y, Sugahara K, Fukuoka T, Saito S, Sakuramoto A, Horii N, Sano S, Hasegawa K, Nakao Y, Nanto T, Kadoi K, Moridera K, Noguchi K, Domen K, Kishimoto H. Change in tongue pressure in patients with head and neck cancer after surgical resection. Odontology 2017; 105:494-503. [PMID: 28197773 DOI: 10.1007/s10266-016-0291-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/20/2016] [Indexed: 12/13/2022]
Abstract
Tongue pressure is reportedly associated with dysphagia. This study investigated relationships among characteristics of head and neck cancer, tongue pressure and dysphagia screening tests performed in patients with head and neck cancer during the acute phase after surgical resection. Fifty-seven patients (36 men, 21 women; age range 26-95 years) underwent surgical resection and dysphagia screening tests (Repetitive Saliva Swallowing Test, Water Swallowing Test, Modified Water Swallowing Test and Food Test) and pre- and postoperative measurement of tongue pressure at 5 time points (preoperatively, and 1-2 weeks and 1, 2, and 3 months postoperatively). Progression of cancer (stage), tracheotomy, surgical reconstruction, chemotherapy, radiotherapy and neck dissection were factors associated with postoperative tongue pressure. Data were analyzed by linear mixed-effect model, Spearman correlation coefficient and receiver operating characteristic (ROC) curve. Tongue pressure was significantly reduced 1-2 weeks after surgery, and recovered over time. Changes in tongue pressure were significantly associated with stage, radiotherapy and reconstruction. All screening tests showed a significant relationship with tongue pressure. Analysis of ROC and area under the effect curve suggested that a tongue pressure of 15 kPa can be used as a cut-off value to detect dysphagia after surgery for head and neck cancer. Our results suggest that tongue pressure evaluation might offer a safe, useful and objective tool to assess dysphagia immediately postoperatively in patients with head and neck cancer.
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Affiliation(s)
- Yoko Hasegawa
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya City, Hyogo, 663-8501, Japan.
| | - Kazuma Sugahara
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya City, Hyogo, 663-8501, Japan
| | - Tatsuyuki Fukuoka
- Department of Physical Medicine and Rehabilitation, Hyogo College of Medicine College Hospital, Hyogo, Japan
| | - Shota Saito
- Department of Physical Medicine and Rehabilitation, Hyogo College of Medicine College Hospital, Hyogo, Japan
| | - Ayumi Sakuramoto
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya City, Hyogo, 663-8501, Japan
| | - Nobuhide Horii
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya City, Hyogo, 663-8501, Japan
| | - Saori Sano
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya City, Hyogo, 663-8501, Japan
| | - Kana Hasegawa
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya City, Hyogo, 663-8501, Japan
| | - Yuta Nakao
- Department of Physical Medicine and Rehabilitation, Hyogo College of Medicine College Hospital, Hyogo, Japan
| | - Tomoki Nanto
- Department of Physical Medicine and Rehabilitation, Hyogo College of Medicine College Hospital, Hyogo, Japan
| | - Kanenori Kadoi
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya City, Hyogo, 663-8501, Japan
| | - Kuniyasu Moridera
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya City, Hyogo, 663-8501, Japan
| | - Kazuma Noguchi
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya City, Hyogo, 663-8501, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Hiromitsu Kishimoto
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya City, Hyogo, 663-8501, Japan
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